COLUMBIA  LIBRARIES  OFFSITE 

I',/}'  III '■<ii  I  if. i  r.MAriDAiiij 


HX64077918 
HA1051  C361896  A  manual  of  medical 


RECAP 


«m  m 


mm 
mi 


■BIB 


WK 


saWBHB 

.-•■■•■'.■ 
■.■■■■■■  ■■'■■:'-    ■ 

1111 

II1I  ■■•■■ 

iflill 

KggKgsHHg 


WJ.  JflSliM  ROSEflT 


RA'ftS"' 


C36. 


Columbia  Untotrsitp 

mfljfCttpofMfmgark 

CoUcgc  of  gfjpsicians  anb  SmrstonS 
librarp 


•     fc; 


i 


A  MANUAL  OF 

MEDICAL  JURISPRUDENCE 

AND 

TOXICOLOGY 


BY 

HENRY  C.  CHAPMAN,  M.  D. 

PROFESSOR  OF  INSTITUTES    OF    MEDICINE    AND    MEDICAL    JURISPRUDENCE    IN    THE 
JEFFERSON  MEDICAL  COLLEGE  OF  PHILADELPHIA  ;    MEMBER  OF    THE    COL- 
LEGE OF  PHYSICIANS    OF    PHILADELPHIA,  OF    THE    ACADEMY    OF 
NATURAL  SCIENCES  OF  PHILADELPHIA,  OF  THE  AMERICAN 
PHILOSOPHICAL  SOCIETY,  AND  OF  THE  ZOOLOGICAL 
SOCIETY   OF  PHILADELPHIA. 


SECOND  EDITION,  REVISED 


WITH  55  ILLUSTRATIONS  AND   3   PLATES  IN  COLORS 


PHILADELPHIA 
W.    B.    SAUNDERS 

925  Walnut  Street 
1898. 


Copyright,  1895, 
By  W.  B.  SAUNDERS, 


7?#  l os-f 

J89C 


PRESS  OF 
W.    B.   SAUNDERS,    PHILADA, 


PREFACE  TO  THE  SECOND  EDITION. 


Since  the  publication  of  the  first  edition  of  this 
work,  in  the  autumn  of  1892,  the  further  experience 
gained  as  a  teacher  of  medical  jurisprudence  has  sug- 
gested to  the  author  the  propriety  of  giving  a  brief 
bibliography  bearing  upon  the  statements  originally 
made  in  the  text  of  the  work  as  based  upon  his  own 
experience  as  Coroner's  physician  to  the  city  of  Phila- 
delphia for  a  number  of  years.  With  that  exception, 
and  the  addition  of  several  new  figures  and  tables,  the 
text  and  scope  of  the  work  remain  essentially  un- 
changed. 

HENEY  C.  CHAPMAN. 

2047  Walnut  Street, 
December,  1895. 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/manualofmedicalj1898chap 


i 


CONTENTS. 


PART  I.— MEDICAL  JURISPRUDENCE. 


CHAPTER  I. 


PAGE 


Importance  of  the  Subject  of  Medical  Jurisprudence — Ordinary 
and  Expert  Witness — The  Coroner's  Physician — Relations  of 
the  Medical  Profession  to  the  Coroner  in  Cases  of  Sudden 
Death,  etc 17 

CHAPTER  II. 

Signs  of  Death — Cessation  of  Circulation  and  Respiration — Loss 
of  Sensibility  of  the  fCyes  to  Light — Ashy  Pallor — Loss  of  Heat 
— Rigor  Mortis — Cadaveric  Spasm — Suggillation  —  Putrefaction 
— Conversion  of  Bodies  into  Adipocere — Length  of  Time  elaps- 
ing since  Death — Remote  and  Proximate  Cause  of  Death — 
Symptoms  and  Post-mortem  Appearance  of  Death  from  Disease 
of  Brain,  Heart,  and  Lungs 24 

CHAPTER  III. 

Manner  of  Making  Post-mortem  Examinations  in  Medico-legal 
Cases — Identification  of  the  Dead — Coroner's  Inquest — Conduct 
of  the  Medical  Witness  in  Court 38 

CHAPTER  IV. 

Medico-legal  Definition  of  Wounds — Comparison  of  Wounds  with 
Weapon  inflicting  them  and  Clothes  of  Deceased — Incised,  Con- 
tused, Penetrating  Wounds — Suicidal,  Homicidal,  Accidental 
Wounds — Gunshot  Wounds — Causes  of  Death  from  Wounds  .      51 


XIV     N  CONTENTS. 

CHAPTEK  V. 

PAGE 

Blood-stains — Chemical,  Microscopical,  Spectroscopical  Methods 
of  Investigation  —  Coagulation  of  Blood  —  Conditions  influ- 
encing Coagulation 62 

CHAPTER  VI. 

Burns  and  Scalds — Death  from  Suffocation  by  Strangulation — 
Hanging — Drowning 81 

CHAPTER  VII. 

Death  from  Starvation — Death  from  Heat  and  Cold — Death  by 
Lightning 92 

CHAPTER    VIII. 

Bape  upon  Children — Bape  upon  Adults — Bape  upon  the  Dead — 
Unnatural  Crimes 97 

CHAPTER  IX. 

Signs  of  Pregnancy — Uncertainty  of  Duration  of  Pregnancy — 
Precocious  Pregnancy — Unconscious  Pregnancy — Pregnancy  in 
the  Dead 107 

CHAPTER  X. 

Foeticide — Development  of  Embryo — Formation  of  Placenta,  of 
Moles — Changes  undergone  by  the  Uterus  during  Pregnancy — 
Of  the  Means  of  Producing  Foeticide — Abortion  from  Natural 
Causes 116 

CHAPTER  XI. 

Infanticide — Live  Birth — Appearance  of  Infant  Born  at  Full 
Term — Means  of  Determining  whether  Child  has  Breathed — 
Docimasia  Pulmonum — Objections  to  Hydrostatic  Test — Doci- 
masia  Circulationis— Size  of  Liver  and  Contents  of  Stomach  in 
New-born  Child— Examination  of  Mother — Signs  of  Becent 
Delivery — Means  by  which  Infanticide  is  Committed  ....    130 


CONTENTS.  XV 

CHAPTER  XII. 

PAGE 

Legitimacy — Inheritance — Protracted  Gestation — Premature  De- 
livery— Viability — Procreative  Power  in  the  Male  and  Female 
—  Impotence  —  Sterility  —  Tenancy  by  Courtesy  —  Paternity — 
Affiliation — Superfoetation — Doubtful  Sex — Hermaphrodism — 
Presumption  of  Death — Presumption  of  Survivorship — Per- 
sonal Identity  of  the  Living 139 

CHAPTER    XIII. 

Feigned  Bodily  Diseases — Hypnotism — Life  Insurance — Medical 
Malpractice — Medical  Kegistration 153 

CHAPTER  XIV. 

Insanity — Varieties  of  Insanity  —  Idiocy — Mania  —  Dementia  — 
Medico-legal  Relations  of  Insanity — Criminal  Responsibility — 
Medico-legal  Terms  in  Insanity — Feigned  Mental  Diseases  .   .    162 


PART  II.— TOXICOLOGY. 
CHAPTER   I. 

Frequency  of  Death  from  Poisoning — Definition  of  a  Poison — 
Mode  of  Action  of  Poisons — Influence  exerted  on  Action  of 
Poisons  by  Habit,  Sleep,  Disease,  etc. — Evidences  of  Poisoning 
derived  from  Symptoms,  Post-mortem  Appearances,  Chemical 
Analysis,  Experiments  upon  Animals,  Circumstantial  Evidence 
— Character  of  the  Evidence  the  Chemical  Expert  may  be 
Expected  to  Give  in  Cases  of  Poisoning 180 

CHAPTER  II. 

Classification  of  Poisons — Irritant  Poisons — Poisoning  by  Mineral 
Acids,  by  Alkalies  and  their  Salts,  Noxious  Gases — Poisoning 
by  Phosphorus,  Arsenic,  Antimony,  Mercury,  Lead,  Copper,  etc. 
— Poisoning  by  Oxalic  Acid,  Carbolic  Acid,  etc. — Poisoning  by 
Decomposed  Food,  Ptomaines,  Neurotic  Poisons — Poisoning  by 
Opium,  Alcohol,  Ether,  Chloroform,  Chloral,  Nux  Vomica, 
Strychnia,  Belladonna,  Stramonium,  Tobacco,  Lobelia,  Hydro- 
cyanic Acid 191 


A  MANUAL  OF 
MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY, 


PAET  I.  MEDICAL  JURISPRUDENCE. 


CHAPTER   I. 

Importance  of  the  subject  of  Medical  Jurisprudence — Ordinary  and 
Expert  Witness— The  Coroner's  Physician — Relations  of  the  Medical 
Profession  to  the  Coroner  in  Cases  of  Sudden  Death,  etc. 

Medical  Jurisprudence,  or  Forensic  Medicine,  or 
Legal  Medicine,  as  the  subject  is  often  also  called,  may  be 
broadly  defined  as  medicine  in  relation  to  Law.  Although 
a  subject  of  very  wide  scope  and  much  practical  import- 
ance, it  is,  nevertheless,  usually  neglected  by  the  students 
of  medicine.  It  is  very  desirable,  however,  that  every 
physician  should  have  some  knowledge  of  medical  juris- 
prudence. The  physician  should  know  what  the  Common- 
wealth expects  of  him  and  has  a  right  to  demand  of  him 
in  his  professional  capacity,  and  he  should  know  his  own 
rights  as  a  medical  expert.  Every  physician,  during  the 
course  of  his  professional  career,  may  be  called  upon  to 
give  testimony  in  cases  of  rape,  foeticide,  infanticide,  death 
from  poison  and  from  other  causes. 

Witnesses,  however,  are  of  two  kinds.  One  is  a  wit- 
ness in  the  ordinary  acceptation  of  the  term,  who  testifies 
simply  to  matters  of  fact  of  which  he  has  personal  kuowl- 
2  17 


18  A   MANUAL   OF 

edge.  The  other  is  a  witness,  who  likewise  testifies  to 
matters  of  fact,  but  concerning  which  he  has  special  pro- 
fessional expert  knowledge,  such  as  the  ordinary  witness 
cannot,  from  the  nature  of  the  case,  be  expected  to  have. 
A  person,  for  example,  happens  to  be  walking  in  the  street. 
He  sees  a  boy  run  over  by  a  street  car,  or  a  man  plunge 
a  dirk  into  another ;  or  the  shot  of  a  pistol  is  heard  and  a 
man  is  seen  to  fall.  This  person  is  a  witness  in  the  ordi- 
nary acceptation  of  the  term.  That  is  to  say,  he  is  liable  by 
the  law  of  the  Commonwealth  to  be  at  any  time  subpoenaed 
to  testify  in  court  to  these  facts.  Such  subpoena,  when 
served,  the  witness  must  obey.  Every  citizen  may  be 
called  upon  to  testify  to  matters  of  fact  of  which  he  has 
personal  knowledge.  The  medical  expert  witness,  how- 
ever, is  of  a  kind  different  from  the  ordinary  witness. 
He  is  called  upon  by  the  prosecution  or  defence  to  give  an 
opinion  or  testimony  as  to  facts  concerning  which  he  is 
especially  qualified  to  express  an  opinion  on  account  of 
his  professional  training.  His  knowledge  of  the  particular 
facts  of  a  case,  however,  will  depend  entirely  as  to  whether 
he  sees  proper  to  make  himself  acquainted  with  them  or 
not.  No  law  can  compel,  for  example,  a  physician  to 
examine  the  contents  of  a  stomach,  with  the  view  of  deter- 
mining whether  they  contain  a  poison,  if  he  refuses  to  do 
so.  The  physician  can  excuse  himself  on  the  ground  that 
he  does  not  feel  competent  to  make  the  chemical  analysis, 
or  that  the  necessities  of  his  practice  do  not  give  him  suffi- 
cient time  to  make  such  analysis,  or  that  giving  testimony 
in  court  at  the  time  of  the  trial  may  interfere  with  other 
professional  engagements,  etc.  The  physician  may  give 
any  such  reasons  he  pleases  for  refusing  to  undertake  a 
medico-legal  investigation,  and  no  law  can  compel  him  to 
do  so. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         19 

Ordinarily  it  would  be  unwise  for  a  young  physician 
not  to  avail  himself  of  an  opportunity  of  giving  testi- 
mony in  court,  since  it  undoubtedly  leads  indirectly  to  a 
great  deal  of  practice  and  professional  preferment  gen- 
erally. If  the  physician  docs  accept  this  responsibility, 
it  is  important  that  he  should  know  exactly  what  his 
duties  will  be  to  the  Commonwealth  under  these  cir- 
cumstances, and  also  what  he  may  expect  from  the  Com- 
monwealth. 

Coroner's  Physicians. — Usually  in  every  large  city  there 
are  appointed  by  the  coroner  one  or  more  "  coroner's  "  phy- 
sicians, whose  duty  it  is  to  make  all  medico-legal  examina- 
tions, or  a  police  magistrate  or  some  such  official  has  the 
power  to  appoint  a  physician  to  conduct  the  same.  It  is 
obvious  that  the  more  attention  any  one  physician  gives  to 
this  kind  of  professional  work,  the  better  qualified  will  he 
be  for  performing  it ;  in  Philadelphia  the  coroner  usually 
appoints  one  physician  as  coroner's  physician,  though  fre- 
quently he  is  allowed  one  or  more  assistants. 

The  compensation  of  the  coroner's  physician  and  assist- 
ants might  either  be  by  the  fee  system  or  by  salary.  The 
latter  is  much  preferable,  for,  if  the  emolument  of  the 
office  depends  upon  the  number  of  post-mortem  examina- 
tions made,  these  examinations  might  be  increased  need- 
lessly. At  the  present  time  in  this  city  the  coroner's  physi- 
cian and  assistant  are  salaried.  Apart,  however,  from  the 
case  of  the  regularly-appointed  and  salaried  coroner's 
physician,  any  physician  may  be  called  upon  by  the 
Commonwealth  or  the  defendant,  in  murder  cases,  for 
example,  to  give  testimony.  It  is  not  only  desirable,  but 
most  important  under  such  circumstances,  that  if  the 
physician  agrees  to  give  his  time  to  the  Commonwealth 
or  the  defence,  the   matter   of  compensation  should  be 


20  A   MANUAL   OF 

first  definitely  fixed.  If  a  physician  be  subpoenaed  as  an 
ordinary  witness,  which  summons  he  must  obey,  and,  having 
given  his  evidence  in  court,  the  Commonwealth  or  the  de- 
fence endeavors  to  obtain  an  expert  expression  of  opinion 
upon  the  facts  testified  to  in  addition  to  the  testimony  as 
to  the  mere  facts  themselves,  the  physician  is  justified  in 
refusing  to  answer.  If,  for  example,  a  physician  happened 
to  see  a  man  stabbed,  and  is  subpoenaed  as  an  ordinary 
witness  to  testify  as  to  the  facts,  he  must  answer  questions 
bearing  directly  upon  such  facts  as  he  observed.  But 
should  the  judge,  prosecuting  attorney,  or  defence  ask  a 
physician  who  has  been  so  subpoenaed  strictly  professional 
questions  which  an  ordinary  witness,  such  as  a  laboring  man, 
could  not  possibly  answer,  and  which  he  alone  can  answer 
on  account  of  his  being  specially  qualified,  the  physician 
in  justice  to  himself  should  refuse  to  answer  them.  The 
court  has  no  more  right  to  take  advantage  of  the  physi- 
cian's professional  knowledge  and  skill  in  extorting  evidence 
without  proper  compensation  than  it  would  have  to  take 
his  property ;  his  knowledge  is  his  property,  his  capital.1 

Relations  of  the  Medical  Profession  to  the  Coroner. — 
While  in  a  general  way  it  is  always  proper  that  every 
law-abiding  citizen  should  contribute  to  the  Common- 
wealth anything  that  lies  in  his  power,  whatever  his 
profession  may  be,  by  which  the  ends  of  justice  will  be 
attained,  it  is  only  right  that  he  should  be  sufficiently 
compensated  by  the  Commonwealth  for  so  doing. 

In  cases  of  persons  dying  suddenly,  from  violence,  or 
within  twenty-four  hours  of  the  time  a  physician  has  been 
in  attendance,  the  coroner  is  notified  by  the  attending  phy- 
sician, members  of  the  family,  or  some  one  interested  in 

1  Vide  Webb  vs.  Page  :  1st  Carrington  and  Kerwin's  Nisi  Prius  He- 
ports,  p.  23. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         21 

the  case.  As  there  is  some  difference  of  opinion  among 
physicians  and  lawyers  as  to  the  interpretation  of  the  law 
bearing  upon  such  cases,  it  is  well  that  the  law  should  be 
stated.  By  the  Act  of  Assembly,  March  22,  1867,  it  is 
provided  :  "  That  it  shall  be  the  duty  of  the  coroner  of  the 
city  and  county  of  Philadelphia  to  hold  an  inquest  on  the 
body  of  any  deceased  person  who  shall  have  died  a  violent 
death,  or  whose  death  shall  be  sudden  ;  provided,  that  such 
sudden  death  be  after  an  illness  of  less  than  twenty-four 
hours,  and  that  no  regular  practising  physician  shall  have 
been  in  attendance  within  said  time,  or  that  suspicious 
circumstances  shall  render  the  same  necessary ;  which  said 
suspicions  shall  first  be  sworn  to  by  one  or  more  citizens 
of  said  city."  Such  being  the  law,  the  attending  physician 
may  say  that,  while  in  cases  of  death  from  violence  or  occur- 
ring under  suspicious  circumstances,  it  is  undoubtedly  his 
duty  to  notify  the  coroner,  this  law  cannot  be  so  inter- 
preted as  to  compel  him  to  notify  the  coroner  in  cases  of 
death  from  chronic  disease,  even  though  he  may  not  have 
been  in  attendance  within  twenty-four  hours  of  death. 

Let  us  suppose  that  a  physician,  in  accordance  with  that 
interpretation  of  the  law,  signs  a  death-certificate,  assign- 
ing some  chronic  disease  as  the  cause  of  death,  not  having 
seen  the  patient  within  twenty-four  hours,  or,  perhaps,  not 
within  a  week  of  death.  It  is  not  impossible  that  in  such 
a  case  suspicions  might  be  aroused  after  burial,  the  body 
might  be  exhumed,  and  a  post-mortem  examination  might 
reveal  poison  as  the  true  cause  of  death.  An  attending 
physician,  under  these  circumstances,  would  certainly  be 
subpoenaed  to  appear  before  the  coroner  to  explain  his 
action,  even  though  he  were  not  held  for  criminal  prose- 
cution. 

It  may  be  urged,  however,  if  the  attending  physician 


22  A   MANUAL   OF 

notifies  the  coroner  in  cases  of  death  from  chronic  disease, 
in  which  he  has  not  been  in  attendance  within  a  period 
of  twenty-four  hours  of  death,  that  the  family  of  the  de- 
ceased will  be  needlessly  annoyed.  It  will  be  said  that, 
on  notification  of  death,  the  coroner  will  hold  an  inquest 
involving  the  bringing  of  his  jury  to  the  house  of  the 
deceased,  making  a  post-mortem  examination,  outraging 
the  feelings  of  the  family,  etc.  As  a  matter  of  fact,  how- 
ever, there  is  no  necessity  that  the  family  should  be 
annoyed  in  the  slightest  degree.  The  coroner,  being- 
notified,  will  either  authorize  the  attending  physician  to 
sign  the  certificate,  or  send  his  physician  to  the  house  to 
simply  inspect  the  body,  and  possibly  to  ascertain  if  the 
family  and  friends  of  the  deceased  are  entirely  satisfied  as 
to  the  cause  of  death. 

On  the  other  hand,  let  us  suppose  that  the  attending  phy- 
sician does  not  notify  the  coroner  in  a  case  of  death  from 
chronic  disease  where  he  has  not  been  in  attendance  within 
a  period  of  twenty-four  hours,  and  that  the  attention 
of  the  coroner  is  called  to  the  fact  that  the  life  of  the  de- 
ceased was  heavily  insured,  or  that  the  insurance  company 
objects  to  the  payment  of  the  premiums  on  that  ground. 
Under  such  circumstances  the  coroner  is  obliged  to  have 
the  body  exhumed,  a  post-mortem  examination  made,  the 
attending  physician  and  members  of  the  family  of  deceased 
perhaps  subpoenaed  to  appear  at  his  office,  the  inquest  only 
proving  that  the  true  cause  of  death  was  such  as  was  first 
assigned  in  the  death-certificate.  All  such  trouble  and 
annoyance  can  be  avoided  in  such  cases  by  simply  notify- 
ing the  coroner.  However,  therefore,  the  law  bearing  on 
such  cases  may  be  interpreted,  why  should  the  attending 
physician   assume    any   responsibility,   and    risk    future 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         23 

trouble  when  there  is  an  official  regularly  appointed  for  the 

investigation  of  such  cases? 

It  is  sometimes  also  held  by  physicians  that  the  law 
cannot  compel  the  attending  physician  to  notify  the  coroner 
in  a  case  of  death  from  violence,  if  death  be  delayed 
several  months  or  years.  Such  an  opinion,  however,  is  a 
misinterpretation  of  the  law,  and  would  not  be  sustained, 
since  it  is  distinctly  stated  in  the  act,  without  qualification, 
that  the  coroner  shall  hold  an  inquest  "  on  the  body  of 
any  deceased  person  who  shall  have  died  a  violent  death." 
Indeed,  even  if  the  attending  physician  were  fully  satisfied 
that  the  cause  of  death  could  not  be  even  remotely  traced 
to  some  act  of  violence  or  injury  suffered  by  the  deceased 
years  before  death,  it  would  be  advisable  for  him  to  notify 
the  coroner  to  relieve  himself  of  any  responsibility,  in  the 
view  of  a  suit  for  damages  possibly  being  instituted. 

Whatever  views  physicians  may  hold  as  to  the  propriety 
of  the  law  regulating  the  conduct  of  the  coroner,  it  is  well 
for  them  to  realize  the  authority  enjoyed  by  that  official,  at 
least  in  this  Commonwealth,  before  entering  into  any  con- 
flict with  him.  The  office  is  an  exceedingly  old  one,  having 
been  in  existence  hundreds  of  years,  antedating  that  of 
any  of  the  judges  of  our  courts.  He  can  subpeena  any 
one  to  his  office  at  any  hour  of  any  day,  and  commit  for 
contempt.  The  coroner  has  an  enormous  amount  of 
authority,  if  he  chooses  to  exercise  it,  and  if  he  abuses  it 
can  give  those  with  whom  he  comes  in  official  contact 
endless  trouble  and  annoyance.  Indeed,  so  true  is  this 
that  the  office  has  been  abolished  in  many  places.  Such 
being  the  case,  so  long  as  the  office  exists,  the  author  would 
recommend  to  physicians  to  notify  the  coroner  in  all  doubt- 
ful cases  involving  his  jurisdiction,  thereby  saving  them- 
selves much  annoyance,  trouble,  and  loss  of  time. 


24       '  A    MANUAL   OP 


CHAPTER  II. 

Signs  of  Death — Cessation  of  Circulation  and  Respiration — Loss  of 
Sensibility  of  the  Eyes  to  Light — Ashy  Pallor — Loss  of  Heat — Rigor 
Mortis — Cadaveric  Spasm — Suggillation— Putrefaction — Conversion 
of  Bodies  into  Adipocere — Length  of  Time  Elapsing  since  Death — 
Remote  and  Proximate  Cause  of  Death — Symptoms  and  Post-mortem 
Appearance  of  Death  from  Disease  of  Brain,  Heart,  and  Lungs. 

It  is  frequently  stated  that  persons  have  been  buried 
alive,  or  we  hear  of  individuals  having  been  aroused  with 
great  difficulty  from  a  state  of  trance  or  catalepsy,  prema- 
ture burial  being  thereby  fortunately  prevented.  If  the 
slightest  doubt  prevails  as  to  whether  a  person  is  dead,  a 
physician  should  certainly  not  give  a  death-certificate,  still 
less  contemplate  opening  the  body.  While  there  is  no 
doubt  that  all  accounts  of  persons  being  buried  alive  are 
very  much  exaggerated,  nevertheless,  as  these  statements 
may  not  be  entirely  without  foundation,  it  is  most  import- 
ant that  the  physician  should  be  familiar  with  the  signs  of 
death.  There  are  a  number  of  signs  by  which  a  living 
body  can  be  distinguished  from  a  dead  body.  The  con- 
tinuous cessation  of  the  circulation  and  respiration  may  be 
regarded  unequivocally  as  indicating  death.1  It  is  im- 
possible to  conceive  of  a  human  being  living  for  any  length 
of  time — an  hour,  for  example — unless  the  heart  beats  or 
the  lungs  expand  and  contract.  Not  unfrequently,  however, 
it  is  very  difficult  to  determine  positively  whether  the 
heart  is  beating  or  not,  or  to  state  positively  that  respira- 
tion has  entirely  ceased. 

Cessation  of   Circulation  and  Respiration. — It  is  well 

1  Tidy,  Charles  Meymott :  Legal  Medicine,  London,  1882,  part  i.  pp. 
32,  36. " 


MEDICAL  JUKISPRUDENOE   AND  TOXICOLOGY.        25 

known  that  certain  animals,  like  the  marmot,  are  in  the 
habit,  during  the  winter  months,  of  hibernating.  This 
condition  is  one  of  deep  and  prolonged  sleep.  The  beats 
of  the  heart  are  reduced  to  three  or  four  to  the  minute; 
the  respirations  are  so  infrequent,  and  follow  each  other 
at  such  long  intervals,  that  the  most  experienced  and  care- 
ful observer  will  often  find  it  difficult  to  convince  himself 
that  the  blood  is  really  circulating,  and  that  the  animal  is 
breathing.  Nevertheless,  such  is  the  case,  for,  toward 
the  spring,  the  creature  begins  to  show  evidence  of  return- 
ing vitality.  The  heart  increases  in  the  strength  and 
number  of  its  beats,  the  respiration  increases  in  its 
frequency  and  force,  and  with  the  spring  once  well  set  in 
the  normal  activity  of  the  animal  is  re-established. 

A  similar  condition  is  presented,  to  a  certain  extent,  in 
the  case  of  human  beings  in  a 'state  of  trance  or  catalepsy, 
and  in  the  case  of  those  who  have  been  suffering  from  pro- 
longed disease  of  a  low  typhoid  state.  Under  such 
circumstances,  the  heart  often  beats  so  slowly  and  in- 
frequently, the  respiratory  movements  of  the  chest  are 
so  slight,  that  the  most  careful  and  closest  inspection  is 
required  to  determine  whether  the  patient  is  alive.  In 
such  cases,  however,  if  a  ligature  be  bound  around  one  of 
the  fingers,  the  part  between  the  ligature  and  the  end  of 
the  finger,  if  the  blood  is  still  circulating,  will  become  a 
deep  red  or  purple  in  color,  through  the  congestion  due  to 
the  arrest  of  the  circulation  at  that  point.  But  no  such 
change  will  be  observed  if  life  is  extinct.  Further,  if 
respiration  has  not  entirely  ceased,  by  placing  a  mirror  in 
front  of  the  mouth  the  watery  vapor  exhaled  can  usually 
be  detected  through  its  condensing  as  a  slight  cloud  upon 
the  glass.  The  presence  of  such  a  cloud,  however  faint, 
is  a  proof  that  the  person  is  still  living. 


26  A   MANUAL   OF 

Loss  of  sensibility  of  the  eyes  to  light  is  a  characteristic 
sign  of  death.  When  a  lighted  candle  is  brought  near  to 
the  eye,  the  pupil  contracts,  and  as  it  is  removed  from  the 
eye  the  pupil  dilates.  This  change  in  the  size  of  the 
pupil  may  be  regarded  as  a  characteristic  of  vitality ;  for, 
though  the  phenomena  may  occur  within  a  few  hours 
after  death,  the  muscular  fibres  of  the  iris,  sooner  or 
later,  like  all  muscular  fibres,  lose  their  power  of  con- 
tractility. Atropia,  also,  on  account  of  its  effect  in 
dilating  the  pupil,  may  be  used  as  determining  whether 
life  is  extinct. 

The  ashy  pallor  of  the  body  may  be  regarded  as  a  sign 
of  death,  though  not  a  characteristic  one,  since  it  is  not 
present  in  death  from  all  diseases,  as  in  a  person  dying, 
for  instance,  from  jaundice  or  from  yellow  fever. 

Loss  of  Heat. — One  of  the  most  remarkable  of  vital 
phenomena  is  the  power  man  possesses  of  maintaining  the 
temperature  of  his  body  at  about  98.6°  F.  whatever  be  the 
character  of  the  surroundings,  whether  the  region  be  tropi- 
cal or  arctic,  whether  the  season  be  winter  or  summer. 
After  death,  however,  the  body  begins  to  lose  heat,  and  at 
first  very  quickly.  During  the  first  three  hours  after 
death  the  body  may  lose  perhaps  as  much  as  four  degrees 
per  hour.  The  temperature  then  progressively  falls  at  the 
rate  of  a  degree  and  a  half  an  hour  until,  within  between 
fifteen  and  twenty-four  hours  after  death,  it  is  that  of  the 
surrounding  atmosphere.1 

Loss  of  heat  is  a  characteristic  sign  of  death,  but  there 

are  certain  conditions  which  influence  the  rate  at  which 

1  Taylor  and  Wilks  :  Guy's  Hospital  Reports,  third  series,  vol.  ix., 
October,  1863,  p.  180;  Niderkorn:  Rigidite  cadaverique  chez  I' Homme, 
Paris,  1872;  Burman :  Edinburgh  Medical  Journal,  vol.  xxv.,  1880,  p. 
993 ;  Goodhart :  British  Medical  Journal,  1874,  p.  303 ;  Guy's  Hospital 
Reports,  1870,  p.  365. 


MEDICAL  JURISPRUDENCE   AND  TOXICOLOGY.        27 

the  body  cools.  Bodies  that  arc  thin  and  emaciated  cool 
more  quickly  than  fat  ones,  fat  being  a  non-conductor. 

The  bodies  of  young  children  lose  heat  more  rapidly  than 
those  of  adults,  and  the  bodies  of  old  people  more  rapidly 
than  those  of  individuals  in  the  prime  of  life.  A  body 
that  is  exposed  to  the  air  will  lose  its  heat  more  quickly 
than  when  it  is  inclosed,  and  a  body  unclothed  will  lose 
heat  more  quickly  than  if  it  were  clothed.  If  the  room 
in  which  a  dead  body  is  lying  be  large  and  airy,  the 
heat  will  be  given  off  more  rapidly  than  if  the  room  be 
a  small,  close,  and  confined  one.  A  body  immersed  in 
water  loses  its  heat  more  rapidly  than  when  it  is  exposed 
to  the  air. 

It  should  be  mentioned  in  this  connection  that  in  per- 
sons dying  from  yellow  fever,  smallpox,  tetanus,  cholera, 
and  from  some  other  acute  diseases,  there  often  occurs  a 
rise  instead  of  a  fall  of  temperature.  The  cause  of  this 
increase  of  temperature,  amounting  in  certain  instances  to 
as  much  as  9°  F.,  is  not  yet  understood. 

Rigor  Ilortis  (cadaveric  rigidity),  or  the  stiffening  of 
the  muscles  throughout  the  body,  is  a  characteristic  sigu  of 
death.  Rigor  mortis  may  set  in  within  three  to  six  hours, 
or  may  be  delayed  until  fifteen  to  twenty  hours,  after  death. 
It  may  last  only  a  few  moments,  or  from  twenty-four  to 
forty-eight  hours,  or  even  weeks.  The  variations  in  time 
of  its  appearance  and  duration  appear  to  depend  upon  the 
previous  condition  of  the  body.  The  order  in  which  the 
muscles  pass  into  the  condition  of  rigor  mortis  is  a  very 
definite  one.  The  muscles  of  the  eye  first  become  rigid  ; 
then  successively  the  muscles  of  the  neck,  chest,  upper  ex- 
tremities, and  finally  the  muscles  of  the  lower  extremities. 
It  should  be  mentioned  in  this  connection,  however,  that 
considerable  difference  of  opinion  has  prevailed  among 


28  A   MANUAL   OF 

those1  who  have  especially  studied  the  phenomena  of 
rigor  mortis  as  to  the  exact  order  in  which  the  dif- 
ferent parts  of  the  body  pass  into  that  condition,  as 
well  as  the  time  of  its  appearance  and  duration.  Rigor 
mortis  disappears  in  the  same  order ;  that  is,  the  mus- 
cles of  the  neck  relax  first.  The  muscles  of  the  ex- 
tremities may  still  be  rigid,  even  though  the  remaining 
muscles  are  relaxed.  After  the  rigor  mortis  has  entirely 
passed  off  the  general  pliancy  of  the  body  is  restored,  and 
decomposition  at  once  begins.  Rigor  mortis  is  due  to  the 
coagulation  of  myosin,  differing  in  this  respect  from  ordi- 
nary muscular  contraction. 

It  is  often  asserted  that  in  certain  instances,  as  in  death 
from  electricity,  and  in  the  case  of  animals  hunted  to 
death,  rigor  mortis  does  not  occur.  This  statement  is 
erroneous,  inasmuch  as  rigor  mortis  is  the  sequence  of 
death  from  any  cause.  But,  in  the  instances  just  men- 
tioned, it  is  so  slight  as  to  escape  observation. 

Cadaveric,  spasm  (spasmodic  rigidity),  or  the  spasm 
often  occurring  at  the  moment  of  death,2  in  the  case  of 
persons  who  have  died  from  sudden  or  violent  deaths, 
though  resembling  rigor  mortis,  and  sooner  or  later  pass- 
ing into  that  condition,  is  not  necessarily  identical  with  it. 
Cadaveric  spasm,  occurring  in  cases  of  suicide,  appears  to 
be  due  to  all  the  vital  energy  having  been  concentrated  in 
the  one  final  muscular  effort,  and  not  at  all  to  coagulation 

1  Nysten :  Recherches  de  Physiologie  et  de  Chimie  pathologiques,  etc.,  p. 
384 ;  Sommer  :  De  Signis  Mortem  Humanis  Absolutem  ante  Putredinis  Ac- 
cessum  Indicantibus,  Havnise,  1833 ;  Particula  Posterior  Caput  Octavium, 
p.  185;  Larcher:  Archives  des  Generates  Medecine,  vol.  i.,  1862,  p.  685; 
Maschka :  Handbueh  der  Gerichtlichen  Medeein,  Dritter  Band,  Tubingen, 
1882. 

2  Brinton  :  American  Journal  of  Medical  Science,  January,  1870;  Og- 
ston :  British  and  Foreign  Medical  Review,  April,  1857,  p.  303. 


MEDICAL   JUKISPRUDENCE   AND   TOXICOLOGY.        29 

of  the  myosin  of  the  muscle.  The  weapon  in  sudi  cases 
is  often  grasped  with  such  firmness  that  after  death  it 
requires  considerable  force  to  remove  it. 

Suggillation. — In  connection  with  the  signs  of  death, 
the  condition  known  as  cadaveric  lividity  or  suggillation 
may  appropriately  be  mentioned.  It  is  the  result  of  the 
settling  of  blood  in  the  capillaries,  and  gives  rise  to  vio- 
let-colored or  livid  patches,  which,  while  at  first  iso- 
lated, afterward  coalesce.  Such  discolorations  are  ob- 
served in  the  most  dependent  parts  of  the  body,  such  as 
the  back,  under  surface  of  the  neck,  calves  of  the  legs,  etc. 
When  occurring  in  the  lungs  and  other  internal  organs, 
cadaveric  lividity  is  known  as  hypostatic  congestion. 
Cadaveric  lividity  is  sometimes  mistaken  for  a  bruise. 
The  latter  condition  can,  however,  readily  be  distinguished 
from  cadaveric  lividity,  since,  if  a  bruise  be  divided  by  a 
scalpel,  either  effused  blood  or  a  clot  will  be  found. 

Putrefaction,  or  the  decomposition  of  nitrogenous  sub- 
stances by  certain  bacteria,  with  the  development  of  gaseous 
foul-smelling  products,  is  usually  regarded  as  the  most  posi- 
tive sign  of  death.1  The  length  of  time  intervening  between 
death  and  the  beginning  of  putrefaction  varies  very  con- 
siderably according  to  the  conditions  of  the  body  as  well 
as  those  of  the  surroundings.  Thus,  fat  and  flabby  bodies, 
those  of  new-born  children,  and  of  women  dying  in 
childbirth,  putrefy  rapidly,  probably  on  account  of  the 
amount  of  fluid  present  in  the  body  under  such  circum- 
stances. The  bodies  of  persons  dying  from  exhaustive 
diseases,  such  as  typhus  fever,  or  from  injuries  involving 
the  bruising  and  mangling  of  the  bodies,  or  from  poison- 
ous gases  like  carbonic  oxide,  etc.,  undergo  putrefaction 

1  Fliigge,  Dr.  C. :  Micro-organhms,  translated  by  W.  W.  Cheyne, 
London,  1890,  p.  608. 


30  A   MANUAL   OF 

quickly.  Putrefaction  is  retarded,  however,  in  cases  of 
death  from  alcohol,  phosphorus,  arsenic,  aud  certain 
narcotic  poisons.  While  the  phenomena  of  putrefac- 
tion are  undoubtedly  due,  as  already  mentioned,  to  the 
presence  of  certain  bacteria,  the  products  of  the  decom- 
position of  the  albuminous  substances  being  subsequently 
modified  by  the  oxidizing  action  of  the  atmosphere,  present 
under  ordinary  circumstances,  nevertheless,  the  rapidity 
of  the  process  will  be  greatly  influenced,  not  only  by  the 
amount  of  moisture  present  in  the  atmosphere,  but  by  the 
temperature  of  the  latter. 

Indeed,  putrefaction  is  arrested  in  the  presence  of  per- 
fectly dry  air.  Thus,  in  the  sandy  deserts  of  Arabia  and 
Africa,  a  dead  body,  losing  rapidly  its  fluids,  dries  up  and 
mummifies,  while  bodies  buried  naked  or  but  very  little 
clothed  in  wooden  coffins,  in  shallow  graves  to  which 
the  air  has  ordinarily  access,  putrefy  rapidly.  The  in- 
fluence of  temperature  in  promoting  or  retarding  putre- 
faction is  well  shown  by  the  fact  that  bodies  putrefy  more 
rapidly  in  summer  than  in  winter.  Indeed,  putrefaction 
is  entirely  arrested  at  a  temperature  of  32°  F.,  as  well 
known  ;  bodies  of  men  and  animals  buried  in  ice  for  nearly 
a  hundred  years  have  been  found  in  a  state  of  perfect 
preservation  after  exhumation.  The  temperature  most 
favorable  to  putrefaction  appears  to  be  between  70°  and 
100°  F.,  a  temperature  of  212°  arresting  it.  Putrefac- 
tion is  undoubtedly  due  to  the  presence  of  bacteria,  its 
progress  being  modified  by  the  condition  of  the  body  at  the 
time  of  death,  the  age  and  sex,  the  amount  of  moisture  in 
and  the  temperature  of  the  atmosphere.  Nevertheless,  as  it 
has  been  observed  that  the  decomposition  of  bodies  of  the 
same  general  character  buried  in  the  same  kind  of  coffins 
and  graves  varies  very  considerably,  there  must  be  other 


MEDICAL   JURISPRUDENCE    AND    TOXICOLOGY.         31 

conditions  than  those  just  referred  to,  and  not  so  well 
understood  in  their  effects,  that  influence  the  rapidity  of 
putrefaction. 

It  may  be  mentioned  that  bodies  putrefy  more  rapidly 
in  air  than  in  water,  and  more  rapidly  in  air  or  water  than 
in  earth.  Inasmuch  as  putrefaction  is  influenced  by  so 
many  conditions,  it  is  impossible  to  state  exactly  when  it 
will  first  appear  or  the  length  of  time  before  a  body  will 
entirely  be  decomposed.  As  a  general  rule,1  it  may  be 
said,  in  the  case  of  bodies  exposed  to  the  open  air,  that 
within  a  period  after  death  of  from  one  to  three  days  in 
summer,  and  three  to  six  days  in  winter,  there  appears  a 
greenish  or  greenish-yellow  spot  upon  the  abdomen  about 
three  inches  in  diameter,  accompanied  by  the  peculiar 
odor  of  putrefaction.  The  eyeball  at  the  same  time  be- 
comes soft  and  yielding.  During  the  next  succeeding  few 
days — three  to  five — this  greenish  discoloration  spreads 
over  the  body  in  coalescing  spots.  Within  ten  days  the 
epidermis  begins  to  loosen,  and  at  the  same  time  blisters 
with  fluid  begin  to  form.  •  The  chest  and  abdomen  be- 
come at  the  same  time  distended  and  swollen  with  the 
gases  which  in  the  mean  time  develop.  The  sphincter  aui 
becomes  relaxed,  and  reddish  streaks  appear  along  the 
course  of  the  blood-vessels.  By  the  end  of  two  or  three 
weeks  the  blisters  have  broken,  maggots  have  made  their 
appearance,  and  the  nails  have  loosened.  The  develop- 
ment of  gases  continuing,  the  abdomen  becomes  very 
much  distended.  The  penis  is  now  enormously  swollen 
and  shapeless,  and  the  scrotum  is  enlarged,  in  some  cases, 
to  the  size  of  a  child's  head.  The  hairs  of  the  head  are 
loose  and  can  readily  be  pulled  out.  Within  a  period  of 
from  four  to  six  months  the  walls  of  the  body-cavities 

1  Casper :  Handbook  of  the  Practice  of  Forensic  Medicine,  -1  vols.,  Lon- 
don, 1861,  vol.  i.  pp.  33,  37,  40,  52. 


32  >  A   MANUAL,   OF 

burst  open,  discharging  their  contents.  The  brain  runs 
out ;  the  soft  parts  have  either  become  pulpy  or  have  dis- 
appeared. The  softened  flesh  falls  away  from  the  bones, 
the  skeleton  thereby  becoming  exposed.  The  sexes  finally 
become  undistinguishable,  except  in  the  case  of  the  uterus 
being  recognized,  the  last  of  the  internal  organs  to  putrefy. 
As  a  general  rule,  the  order  in  which  the  internal  organs 
putrefy  is  quite  a  regular  one.  Inferences  from  their  con- 
dition as  to  the  time  elapsing  since  death  are  far  more 
trustworthy,  therefore,  than  those  based  upon  an  examina- 
tion of  the  body  externally.  The  first  part  of  the  body  to 
putrefy  internally  is  the  mucous  membrane  of  the  larynx 
and  trachea,  which  becomes  in  color  a  dirty  red,  at  the 
same  time  that  the  abdomen  becomes  greenish  externally, 
as  just  described.  The  next  organ  to  decompose  is  the  brain 
of  young  infants.  Then  follow  the  stomach  and  intes- 
tines. In  this  connection  it  should  be  mentioned  that  the 
ordinary  post-mortem  redness  of  the  mucous  membrane  of 
the  stomach  often  resembles  so  closely  that  due  to  poison- 
ing, that  the  superficial  examiner  might  be  readily  de- 
ceived, and  attribute  such  a  condition  to  poison  having 
been  taken.  The  spleen,  omentum,  and  mesentery,  and 
liver,  if  healthy  at  time  of  death,  may  resist  putrefaction 
for  several  weeks.  The  brain  in  the  adult,  though  a  soft 
structure,  does  not  usually  putrefy  before  the  fourth  or 
fifth  week.  The  next  organs  to  putrefy  are  usually  the 
heart  and  lungs.  Then  follow  the  kidneys,  oesophagus, 
pancreas,  diaphragm,  and  arteries.  The  last  organ  to  de- 
compose is  the  uterus.  In  certain  cases  the  uterus  has 
been  recognized  even  seven  months  after  death.  This  fact 
is  an  important  one,  as  we  shall  see  hereafter  in  considering 
such  questions  as  the  possibility  of  a  pregnancy  having 
existed,  of  a  foeticide  having  been  committed,  etc. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         ?>?> 

Conversion  into  Adipocere. — Under  certain  circumstances, 
a  dead  body,  instead  of  undergoing  putrefaction  in  the  ordi- 
nary manner,  is  converted  into  the  substance  known  as 
"adipocere,"  so  called  on  account  of  its  general  resem- 
blance to  a  combination  of  fat  and  wax.1  Adipocere,  being 
chemically  either  ammonium  or  calcium  stearate  or  oleate, 
is  probably  produced  through  the  combination  of  a  fatty 
acid  of  the  fat  with  the  ammonium  resulting  from  the  de- 
composition of  the  nitrogeneous  tissues,  the  ammonium 
being  often  replaced  afterwards  by  calcium.  The  forma- 
tion of  adipocere  being  therefore  a  saponification,  the 
presence  of  water,  as  might  be  expected,  is  e.ssential  to  its 
production.  Dead  bodies  are,  therefore,  converted  into 
adipocere  only  in  graves  containing  water,  or  in  wet  or  at 
least  very  moist  soil.  Inasmuch  as  dead  bodies  lying  in 
water  for  any  length  of  time  may  be  converted  into  adipo- 
cere, it  becomes  a  matter  of  importance  to  determine  the 
length  of  time  required  for  such  conversion,  since  it  will 
enable  the  medicaf  examiner  to  state,  in  a  general  way  at 
least,  how  long  the  body  has  been  lying  in  the  water  when 
it  was  found.  As  the  result  of  observations  and  experi- 
ments it  may  be  said  that,  on  the  average,  the  body  of  a 
new-born  child  will  be  changed  into  adipocere  after  re- 
maining in  water  between  five  and  six  weeks.  An  adult 
body  requires,  for  complete  conversion  into  adipocere,  one 
year  if  immersed  in  water,  and  three  years  or  more  if 
buried  in  wet  earth.2 

Length  of  Time  Elapsing  since  Death. — Having  de- 
scribed in  a  general  way  the  signs  of  death,  there  still 

1  Fourcroy  :  Annates  de  Chimie,  tome  v.,  1790,  p.  154 ;  tome  vii.  p.  17 ; 
Ohevreul :  ibid.,  tome  xcv.  p.  5;  Orfila  et  L&sueur:  Tiuiie  des  Ex- 
humations juridiques,  tome  i.,  Paris,  18ol,  p.  351;  Schaueustein  in 
Maschka,  vol.  iii.  S.  445. 

2  Devergie :  Medecim  legale,  tome  i.,  Paris,  p.  97. 

3 


34  A  MANUAL  OF 

remains  for  consideration  the  question  as  to  the  medical 
examiner  being  enabled  from  such  signs  alone  to  deter- 
mine positively  the  length  of  time  which  has  elapsed 
since  death.  That  it  is  highly  important  that  the  medical 
examiner  should  be  able  to  give  such  testimony  has  been 
well  shown  in  cases  of  murder,  such  as  those  in  which  the 
defendant  proved  an  alibi,  but  in  which  it  was  also  proved 
by  the  medical  testimony  that  the  wounds  causing  the 
death  were  not  inflicted  during  the  period  that  the  defend- 
ant claimed  he  was  absent.  It  must  be  remembered,  how- 
ever, notwithstanding  the  verdict  of  guilty  in  the  cases 
just  referred  to,  that  any  estimate  as  to  the  length  of  time 
elapsing  since  death  based  upon  post-mortem  examination 
alone  can  only  be  approximative.  In  a  general  way, 
therefore,  it  can  only  be  stated  in  the  case  of  the  body 
being  unburied  and  exposed  to  the  atmosphere,  that  if  the 
body  is  only  slightly  cold  and  the  jaws  beginning  to 
stiffen,  the  eyes  glazed  and  the  eyeballs  sunken,  death  has 
occurred  within  a  period  of  from  fifteen  minutes  to  four 
hours.  If,  however,  the  entire  body  be  cold  and  rigid, 
the  abdomen  has  turned  green  and  the  odor  of  putrefaction 
is  perceptible,  the  body  is  cold  and  pliant,  and  there  is  cadav- 
eric lividity,  the  rigor  mortis  having  passed  away,  death 
has  taken  place  within  from  one  to  three  days  in  summer 
and  from  three  to  six  days  in  winter.  If  greenish-brown 
stains  and  dark  red  lines  are  found  extending  more  or  less 
over  a  greenish-yellow  body,  together  with  relaxation  of 
the  sphincter  ani  muscle,  then  death  has  occurred  within 
a  period  of  from  eight  to  ten  days  in  summer,  ten  to 
twenty  days  in  winter.  If  the  entire  body  is  green,  the 
chest  and  abdomen  enormously  distended,  if  open  blisters 
are  found  over  the  skin,  and  maggots  in  the  muscles,  the 
nails  falling  out,  the  color  of  the  eyes  unrecognizable,  then 


MEDICAL   JUEI8PRUDENCE   AND   TOXICOLOGY.        35 

death  has  occurred  within  a  period  of  from  two  to  three 
weeks  in  summer,  of  from  four  to  six  weeks  in  winter.  If 
the  contents  of  the  chest  and  abdomen  have  been  dis- 
charged, some  of  the  bones  bare,  the  eyes  enormously 
swollen,  death  has  taken  place  within  a  period  of  from 
four  to  six  months.  Whatever  be  the  remote  cause  of  death 
in  any  particular  instance,  whether  it  be  due  to  disease, 
injury,  wounds,  or  fractures,  it  may  be  referred  approxi- 
mately, at  least,  to  an  arrest  of  the  action  of  the  brain, 
heart,  or  lungs.  In  order  to  be  able  to  determine  the 
cause  of  death,  the  medical  examiner  should  be  familiar 
with  the  symptoms  of  death  as  due  to  the  three  causes 
just  mentioned,  together  with  the  post-mortem  appearance 
accompanying  them. 

Symptoms  and  Post-mortem  Appearances  of  Death  from 
Diseases  of  the  Brain,  Heart,  and  Lungs. — The  symptoms 
of  death  beginning  at  the  brain,  or  coma,  are  stupor, 
insensibility  to  external  impressions,  loss  of  conscious- 
ness, slow,  stertorous,  irregular  breathing;  the  respira- 
tion and  circulation  ceasing  as  the  medulla  becomes 
affected.  The  post-mortem  appearances  presented  in  the 
case  of  death  beginning  at  the  brain  are  effusion  of  blood 
into  the  cavities,  due  to  apoplexy,  rupture  of  the  blood- 
vessels from  fracture  of  the  skull,  embolism,  abscess,  con- 
gestion, and  compression.  Death  beginning  at  the  heart 
or  syncope  may  be  due  to  a  deficiency  in  the  quantity  of 
the  blood  or  anaemia ;  or  in  the  quality  or  asthenia.  Death 
from  anremia  may  be  caused  by  rupture  of  an  aneurism,  or 
from  a  uterine  hemorrhage,  or  from  a  division  of  a  large 
vessel  like  the  carotid  artery.  The  symptoms  of  such  con- 
ditions are  paleness,  lividity  of  lips,  dimness  of  vision, 
vertigo,  slow,  fluttering,  weak  pulse,  ringing  in  the  ears, 
hallucination,  with  more  or  less  delirium  and  nausea  and 


36  A   MANUAL   OF 

loss  of  brain  power.  On  post-mortem  examination  the 
heart  is  usually  found  contracted  and  empty,  especially  if 
the  latter  is  examined  shortly  after  death. 

Death  due  to  the  asthenic  condition  occurs  in  fatty  de- 
generation of  the  heart,  in  exhaustive  diseases  of  any  kind, 
starvation,  and  in  poisuning  from  prussic  acid.  The  symp- 
toms in  such  cases  are  cold  hands  and  feet,  lividity  of  lips, 
nose,  and  extremities,  great  muscular  weakness,  feeble 
pulse,  senses  and  intelligence  retained  usually  till  the  last. 
After  death  the  heart  is  found  contracted,  or  its  cavities  are 
dilated  and  flabby,  and  contain  blood. 

Death  beginning  at  the  lungs,  or  asphyxia,  is  caused  by 
mechanical  obstacles,  such  as  foreign  bodies  in  the  air- 
passages.  Respiration  may  be  arrested  by  spasm  of  the 
glottis,  due  to  nervous  excitement,  or  by  paralysis  of  the 
respiratory  muscles.  The  symptoms  of  a  person  dying 
from  asphyxia  are  lividity  of  the  face,  great  dyspnoea, 
vertigo,  loss  of  consciousness,  and  convulsions.  In  death 
from  asphyxia  the  venous  system  and  the  right  side  of 
the  heart  and  lungs  are  found  filled  with  dark  blood. 
The  left  side  of  the  heart  and  the  arterial  system,  if  rigor 
mortis  has  set  in,  are,  however,  usually  found  empty. 

Whatever  may  be  the  remote  cause  of  death,  the  imme- 
diate cause  is  then  to  be  looked  for  in  the  brain,  heart,  or 
lungs.  A  characteristic  set  of  symptoms  precedes  death 
accompanied  by  characteristic  post-mortem  appearances  in 
most  cases.  The  medical  examiner  should  be  able,  there- 
fore, to  usually  determine  at  the  least  the  approximate  cause 
of  death.  It  sometimes  happens,  however,  that  notwith- 
standing that  the  symptoms  are  known,  and  that  a  most 
careful  post-mortem  examination  has  been  made,  the  cause 
of  death  cannot  be  positively  determined.  Under  such 
circumstances  it  may  be  supposed  that  there  has  been  a 


MEDICAL   JURISPRUDENCE   AND  TOXICOLOGY.        o*7 

sudden  stoppage  of  the  heart  through  reflex  nervous  in- 
hibition, as  oecurs  in  persons  who  have  drunk  cold  water 
when  in  an  overheated  condition,  or  as  the  result  of  sonic 
violent  emotion.  In  such  eases  no  post-mortem  lesion  of 
any  kind  may  be  found.  It  can  only  be  said  then  that 
death  may  be  supposed  to  have  been  due  to  some  nervous 
influence.  It  is  not  worth  while,  however,  for  the  medi- 
cal examiner  to  guess  or  speculate  about  the  cause  of  death. 
The  most  prudent  course  to  pursue,  in  reply  to  any  ques- 
tions, is  to  admit  that  the  cause  of  death  cannot  be  stated. 


38        "  A   MANUAL  OF 


CHAPTER   III. 

Manner  of  making  Post-mortem  Examinations  in  Medico-legal  Cases — 
Identification  of  the  Dead— Coroner's  Inquest — Conduct  of  the  Med- 
-  ical  Witness  in  Court. 

Autopsies. — In  cases  of  sudden  death,  or  death  from 
violence,  or  death  under  suspicious  circumstances,  the 
coroner  views  the  body,  and  if  not  satisfied  as  to  the  cause 
of  death,  directs  his  physician  to  make  a  post-mortem 
examination,  the  extent  and  thoroughness  of  which  will 
depend  entirely  upon  his  discretion.  It  is  essential  that 
the  results  of  the  examination  should  be  recorded  at  once 
in  a  book  kept  for  that  purpose,  the  examiner  not  waiting 
until  he  reaches  his  home,  trusting  to  his  memory  for  the 
facts.  Neither  should  the  record  of  the  post-mortem  ex- 
amination made  in  one  book  at  the  time  be  transferred 
later  to  another  book,  since  the  objection  may  be  made 
that  the  two  records  are  not  the  same.  It  is  needless  to 
add  that  the  coroner's  physician  should  have  his  name 
and  address  distinctly  written  in  his  note-book,  so  that  in 
case  it  is  lost,  it  may  be  advertised  for,  or  the  opportunity 
afforded  for  its  return  to  its  owner  without  delay. 

Before  recording  the  results  of  the  post-mortem  ex- 
amination, the  place,  the  year,  the  day  of  the  month,  and 
the  hour  of  the  day  should  be  noted  by  the  examiner. 
The  deceased  must  then  be  identified  from  their  own  per- 
sonal knowledge,  and  not  from  hearsay,  by  two  witnesses 
who  knew  the  individual  upon  whom  the  post-mortem  is 
to  be  made.1    The  height  of  the  deceased  should  then  be 

1  The  medico-legal  questions  as  to  the  importance  of  the  corpus 
delicti  of  proving  that  a  death  took  place  are  well  considered  in 
Wharton  and  Stille:  Medical  Jurisprudence,  3  vols.,  fourth  edition, 
Philadelphia,  1884,  vol.  iii.  p.  613. 


MEDICAL    JURISPKUDKNCE    AND    TOXK'ODifiV.         39 

determined,  the  examiner  being  always  provided  for  this 
purpose  with  a  tape-measure.  This  may  become  an  im- 
portant part  of  the  testimony  in  certain  cases,  like  that 
of  murder,  since  it  may  be  claimed  that  the  deceased 
being  a  taller  man,  and  presumably  heavier  and  stronger 
than  the  defendant,  the  murder  was  committed  in  self- 
defence.  The  body  of  the  deceased  should,  therefore,  be 
weighed.  In  a  properly-equipped  morgue  means  are 
provided  for  this  purpose.  In  their  absence  the  weight 
of  the  body  can  at  least  be  approximately  estimated,  and 
an  idea  can  be  obtained  as  to  whether  the  deceased  was 
strong,  well-built,  muscular,  or  weak,  sickly,  emaciated. 
The  temperature  of  the  body  and  surrounding  atmosphere 
should  be  noted ;  that  of  the  morgue  would  usually  be 
constant ;  but  if  the  post-mortem  examination  be  made 
elsewhere — in  a  bar-room,  in  a  yard,  or  in  a  field — the 
temperature  would  be  variable,  according  to  circumstances, 
season  of  the  year,  etc.  If  the  medical  examiner  be  called 
upon  to  make  an  examination  of  a  dead  body  in  the  place 
where  it  was  first  found,  it  is  very  important  that  all  the 
surroundings  should  be  most  carefully  and  critically  ob- 
served. If  the  dead  body  be  found  in  a  room,  for  ex- 
ample, its  condition  should  be  noted  as  to  the  position  of 
the  tables,  chairs,  china — whether  the  room  was  in  order 
or  confusion,  the  latter  being  probably  the  state  in  the  case 
of  there  having  been  a  struggle.  The  floor,  walls,  doors, 
windows,  and  furniture  should  be  carefully  examined  for 
blood-stains  or  stains  of  any  kind,  foot-marks.  The  con- 
dition of  the  clothing  of  the  deceased  should  be  noted  as 
to  whether  it  was  cut  or  torn,  etc.  Indeed,  no  fact  of  any 
kind  that  could  directly  or  indirectly  aid  in  determining 
the  cause  of  death,  or  lead  to  the  arrest  and  conviction  of 


40        '  A   MANUAL   OF 

the  murderer,  if  murder  has  been  committed,  should  fail 
to  be  recognized  and  recorded  by  the  medical  examiner. 

A  thorough  examination  having  been  made  of  the  body 
externally,  and  the  situation,  extent,  and  nature  of  the 
external  injuries  having  been  noted,  if  any  such  be  present, 
the  body  should  next  be  examined  internally.1  Iu  making 
the  internal  examination  it  is  best  to  begin  with  the  head, 
except  in  cases  of  asphyxia,  as  in  such  cases  if  the  head  is 
opened  first  the  blood  is  apt  to  run  out  of  the  right  side 
of  the  heart.  The  scalp  haviug  been  divided,  and  the 
two  parts  everted,  the  skull,  after  it  has  carefully  been  ex- 
amined, should  then  be  sawed  through  in  such  a  manner 
that  the  calvaria  2  can  securely  be  replaced.  The  dura 
mater,  having  been  inspected,  should  then  be  divided  and 
the  condition  of  the  arachnoid  and  pia  mater  be  observed. 
The  brain  before  removal  should  be  examined  as  to  con- 
gestion of  its  vessels,  laceration  of  its  substance,  extravasa- 
tion of  blood,  etc.     After  removal  of  the  braiu  the  base  ot 

1  Orth,  Dr.  Johannes :  Compend  of  Diagnosis  in  Pathological  Anatomy, 
with  directions  for  making  Post-mortem  Examinations,  translated  by  F.  E. 
Shattuck,  M.  D.,  and  G.  K.  Sabine,  M.  D.,  New  York,  1878 ;  Virchow, 
Professor  Rudolph :  Post-mortem  Examinations  ivith  especial  reference  to 
Medico-legal  Practice,  translated  by  J.  P.  Smith,  M.  D.,  Philadelphia, 
1880;  Casper:  op.  cit.,  vol.  i.  p.  87. 

2  The  word  calvarium,  often  used  synonymously  with  calvaria,  does 
not  appear,  so  far  as  known  to  the  writer,  to  have  been  made  use  of  by 
Latin  authors.  The  neuter  plural  calvaria  was  used,  however — for  ex- 
ample, by  Ennius  in  his  description  of  certain  marine  animals:  "Poly- 
pus Corcyrse,  Calvaria  purgina  acarnse,  Purpura,  Muriculi,  Murex. 
dulces  quoque  echini''  (Enniarixe  Poesis  Beliquim,  Lipseae,  1854,  p.  167). 
The  acarnse  mentioned  by  Ennius  are  probably  the  fish  referred  to 
under  that  name  by  Aristotle  and  Pliny — the  Pagellus  acharne  of 
Cuvier.  Apuleius  also  uses  the  word  calvaria,  not,  apparently,  in  the 
same  sense  in  which  that  word  is  used  by  Ennius  as  parts  of  the 
Acarne,  but  as  if  the  calvaria  were  distinct  animals,  the  latter  being 
referred  to  as  "Marina  calvaria"  (L.  Apuleii,  Opera  Omnia,  Lipsea?, 
1842,  pp.  520,  531). 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         41 

the  skull  should  be  carefully  examined  for  fractures.    The 

condition  of  the  brain  should  be  noted  as  to  its  consistence, 
color,  the  existence  of  tumors,  abscesses.  The  spinal  column 
should  next  be  opened  through  its  whole  extent,  and  the 
cord  removed,  and  its  condition  noted.  The  thorax  and 
abdomen  should  then  be  opened  by  making  an  incision 
extending  from  the  root  of  the  neck  to  the  pubes,  dividing 
the  cartilages  of  the  ribs,  and  the  sterno-clavicular  liga- 
ments, and  reflecting  the  sternum.  The  heart  and  lungs, 
larynx  and  trachea  should  be  at  once  examined  in  situ, 
and  after  removal,  parts  of  the  organ  being  preserved.  The 
stomach  having  been  ligated  at  both  the  cardiac  and  pyloric 
orifices,  each  orifice  being  secured  by  two  ligatures,  should 
then  be  removed  by  cutting  between  the  two  ligatures  at 
each  orifice,  and  placed  in  a  clean  glass  jar.  The  intestines 
should  be  removed  and  preserved  in  a  similar  manner, 
though  separately  from  the  stomach.  The  condition  of  the 
liver,  spleen,  pancreas,  kidneys,  and  uro-genital  apparatus 
should  be  noted  and  portions  of  the  organs  preserved  for 
microscopic  examination  if  necessary. 

WEIGHTS   OF   ORGANS   OF   ADULTS.1 

Heart,  male 11  oz. 

"       female 9   " 

Brain,  male 49J  " 

"      female ' .    .    .  44  " 

Spinal  cord 1-lf  " 

Liver 50-60  " 

Pancreas 2J-3J  " 

Spleen 5-7  " 

Lungs  (together),  male 45  " 

Lungs  (together),  female 32  " 

Thyroid  body 1-2  " 

Thymus  at  birth £  " 

Kidneys  (together) 9  " 

1  Woodman  and  Tidy  :  A  Handy-Book  of  Forensic  Medicine,  etc.,  p.  11. 


42  A   MANUAL   OF 

Weights  of  Organs  of  Adults— Continued. 

Suprarenal  capsules 2  dr. 

Prostate  gland 6 

Testicles  (together) f-1  oz. 

Unimpregnated  uterus • 7-12  dr. 

The  post-mortem  examination  having  been  concluded,  the 
calvaria  should  be  replaced  in  position,  the  parts  of  the 
scalp  inverted,  and  the  latter  as  well  as  the  abdominal 
walls  brought  together  and  securely  sewed.1 

Identification. — Ordinarily  the  dead  body  submitted  for 
medical  examination  is  either  entire  or  almost  so.  Not 
infrequently,  however,  the  body  has  been  purposely  muti- 
lated after  death,  by  a  murderer,  for  example,  with  the 
view  of  escaping  detection,  or  as  in  cases  of  death  from 
fire,  explosions,  railroad  accidents.  Under  such  circum- 
stances, when  often  only  parts  of  the  body  or  bodies  can 
be  recovered  for  examination,  the  highest  anatomical  skill 
may  be  requisite  for  the  identification  of  the  remains  or 
the  determination  of  the  cause  of  death.  But  little  diffi- 
culty, however,  should  be  experienced  in  determining,  for 
example,  whether  the  bones  recovered  be  human  or  not,  if 
the  greater  part  of  the  skeleton,  especially  if  parts  of  the 
skull,  be  submitted  for  examination.  It  is  only  when  a 
bone  or  a  fragment  of  a  bone  has  been  obtained,  as  from 
the  ruins  of  a  fire,  that  mistakes  as  to  their  true  nature 
are  likely  to  be  made  by  the  medical  examiner.  Inas- 
much as  the  bones  of  the  domestic  animals  have  been 

1  In  this  connection  it  should  be  mentioned  that  in  cases  involving 
life  or  death  the  post-mortem  examination  should  be  thorough,  lest  the 
defence  urge  that  the  true  cause  of  death  be  other  than  that  alleged. 
In  more  than  one  case  through  such  neglect  has  the  prosecution  failed 
to  convict,  owing  to  some  organ  not  having  been  examined  (Taylor, 
Alfred  Swayne  :  Manual  of  Medical  Jurisprudence,  eleventh  American 
edition,  by  Clark  Bell,  Esq.,  Philadelphia,  1892,  p.  23). 


MEDICAL   .TURISPKITDENCB    AND   TOXICOLOGY. 


43 


frequently  mistaken  for  those  of  man,  even  by  physicians, 
if  the  examiner  be  in  doubt  as  to  the  nature  of  a  hone,  it 
would  be  better  for  him  to  submit  it  to  a  comparative 
osteologist  for  determination,  rather  than  to  trust  to  his 
own  judgment,  unless  specially  qualified  by  previous  osteo- 
logical  studies  to  give  an  opinion  on  the  subject. 

As  regards  the  skull  more  especially,  there  is  usually  no 
difficulty  in  determining  whether  a  skull  be  a  human  one. 
The  particular  race,  however,  cannot  always  be  indicated, 
for  while  there  is  no  difficulty,  for  example,  in  distinguish- 
ing a  Caucasian  skull  (Fig.  1)  from  that  of  a  typical  negro 


Fig.  1. 


Fig.  2. 


The  facial  angle  of  Camper;  in 
European  crania  usually  it  does  not 
exceed  80°  (a,  b,  c,  d,  lines  forming 
the  facial  angle). 


Facial  angle  of  Camper;  in  the  Ne- 
gro about  70°  (a,  b,  c,  d,  lines  forming 
the  facial  angle). 


(Fig.  2),  it  is  not  only  difficult,  but  often  impossible  to 
exactly  identify  the  many  forms  of  skull  intermediate  in 
character  between  the  two.  In  the  identification  of  human 
remains  the  sex,  age,  and  stature  are  usually  to  be  deter- 
mined. Inasmuch  as  the  skeleton  of  the  male  differs  from 
that  of  the  female  as  regards  the  size,  weight,  strength  of  the 
bones,  in  the  relative  development  of  the  ridges  and  promi- 
nences serving  for  the  attachment  of  the  muscles,  and  more 
particularly  in  the  size  and  shape  of  the  pelvis  (Figs.  3,  4), 
all  of  which  peculiarities  are  fully  described  in  works  on 
anatomy,  there  is  usually  no  difficulty  if  the  skeleton  is 


44 


A  MANUAL  OF 


entire  in  determining  whether  it  be  that  of  a  male  or  a  female. 
If,  however,  a  single  bone  or  a  fragment  of  a  bone  be  sub- 


Fig.  3. 


Fig.  4. 


Male  pelvis. 


Female  pelvis. 


mitted  for  an  examination  it  is  often  so  difficult  to  deter- 
mine the  sex  that  no  positive  opinion  should  be  expressed. 
The  age  of  a  body  can  be  approximately  at  least  in- 
ferred from  the  development  of  the  teeth  and  the  extent 
of  the  ossification  of  the  bones.  It  is  important,  there- 
fore, that  the  medical  examiner  should  be  familiar  with 
the  period  and  order  in  which  the  teeth  appear  and  the 
bones  ossify.  In  the  jawrs  of  a  child  at  full  term  there 
are  usually  found  the  rudiments  of  twenty  primary  and 
four  secondary  or  permanent  teeth,  twenty-four  teeth  in 
all.  The  average  date  of  the  eruption  or  cutting  of  the 
primary  or  milk  teeth  is  as  follows :  The  four  central  in- 
cisors appear  from  five  to  eight  months  after  birth,  the 
four  lateral  incisors  from  seven  to  ten  months,  the  four 
anterior  molars  from  twelve  to  sixteen  months,  the  four 
canines  from  fourteen  to  twenty  months,  and  the  four  pos- 
terior molars  from  eighteen  months  to  three  years.1  At  a 
period  of  life  varying  between  six  and  seven  years  the 

1  Bell,  T. :  Anatomy,  Physiology,  and  Diseases  of  the  Teeth,  1837,  pp. 
66,  79. 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.        45 

jaws  contain  forty-eight  teeth — twenty  milk  teeth  and 
twenty-eight  permanent  teeth  situated  behind  the  milk 
teeth,  which  they  will  replace  as  the  former  are  shed. 
The  order  in  which  the  permanent  teeth  appear  is  as  fol- 
lows :  The  four  anterior  molars  appear  at  seven  years,  the 
four  central  incisors  at  eight  years,  the  four  lateral  incisors 
at  nine  years,  the  four  anterior  premolars  at  ten  years, 
the  four  posterior  premolars  at  eleven  years,  the  four 
canines  at  about  twelve  years,  the  four  second  molars  at 
about  fourteen  years,1  the  four  posterior  molars  at  from 
eighteen  to  twenty-one  years  of  age.  As  a  general  rule, 
the  teeth  of  the  lower  jaw  appear  first,  but  in  this  respect 
there  are  exceptions,  as  also  in  the  order  of  the  appearance 
of  the  teeth.  It  should  be  mentioned  in  this  connection, 
also,  that  in  cases  of  rickets  the  cutting  of  teeth  is  often 
delayed,  while  in  syphilis  it  is  premature.2  In  the  latter 
case  the  teeth  have  a  notched  appearance,  and  often  crumble 
away.  With  the  loss  of  the  teeth  and  progressive  absorp- 
tion of  the  alveolar  processes  due  to  age,  the  lower  jaw 
undergoes  a  marked  change  in  the  widening  of  the  angle 
of  its  neck,  and  in  the  diminution  of  the  width  of  its  body, 
imparting  to  the  mouth  that  expression  so  characteristic  of 
the  aged. 

The  degree  of  ossification  of  the  lower  epiphysis  of  the 
femur  (Fig.  5)  is  one  of  the  most  certain  signs  of  the  age 
of  the  foetus  and  of  the  new-born  child.3  Thus  if  no  os- 
sific  deposit  be  found  in  the  cartilaginous  epiphysis  of  the 

1  Saunders,  Edwin  :  "  The  Teeth  a  Test  of  Age,  considered  with  Refer- 
ence to  the  Factory  Children/'  addressed  to  the  members  of  both  houses 
of  Parliament,  London,  1837,  p.  42. 

2  Woodman  and  Tidy :  Handy  Book  of  Forensic  Medicine  and  Toxi- 
cology, London,  1877,  p.  623. 

3  Beclard  :  Xmtrclle  Journal  dc  Mrderine,  Chirvrgie  el  Pharmaeie,  tome 
iv.,  1819,  p.  113;  Casper:  op.  cit.,  vol.  iii.  p.  23. 


46 


A    MANUAL    OF 


femur  it  may  be  stated  that  the  foetus  has  not  yet  reached 
the  eighth  month  of  intrauterine  life.  If  the  ossific  deposit 
has  attained  a  diameter  of  about  one  line  the  foetus  has 
reached  full  term.     If  the  ossific  deposit  measures  more 


Fig.  6. 


Fig.  5. 


From  a  child  at  birth, 
showing  a  nucleus  in  the 
lower  epiphysis. 


The  natural  skeleton  of  a  child  about  two  years  old. 


than  one-quarter  of  au  inch  the  child  has  lived  after 
birth  for  some  little  time.  The  length  of  the  skeleton 
of  the  child  at  birth  is  usually  about  sixteen  inches. 
Ossification  begins  at  the  extremities  of  most  of  the  long 


MEDICAL   JUKISPBUDENCE    AND   TOXICOLOGY.        47 

bones  at  the  end  of  the  first  year,  and  progresses  from  that 
time  on  until  ossification  is  completed.  The  epiphyses  <>l 
all  the  long  bones  are  usually  found  united  to  their  shafts 
in  the  male  at  about  twenty-four  years,  in  the  female  at 
about  twenty-two  years.  After  ossification  has  once  been 
completed  it  is  extremely  difficult,  if  possible,  to  deter- 
mine exactly  the  age  from  an  examination  of  the  skeleton 


Fig.  7. 


Sternum. 


Sacrum.    (Anterior  surface.) 


alone.  It  may  be  mentioned,  however,  that  the  bones 
of  the  sternum  (Fig.  7)  are  usually  found  ununited  until 
after  forty,1  those  of  the  sacrum  (Fig.  8)  and  os  coccygis 
until  sixty  years  of  age.     The  height  of  a  body  may  be 

1  Guy  and  Ferrier:  Principles  of  Forensic  Medicine,  London,  1881,  p. 
36 ;  Wharton  and  Stille :  Medical  Jurisprudence,  3  vols.,  fourth  edition, 
Philadelphia,  1884,  voh  iii.  p.  470, 


48  A   MANUAL   OF 

approximately  estimated  from  the  skeleton,  the  latter 
being  entire,  by  placing  the  bones  in  position  and  adding 
from  one  inch  and  a  half  to  two  inches  to  the  length  to 
supply  the  missing  soft  parts.  In  the  absence  of  the  skull 
there  should  be  added  about  ten  inches  to  the  height  of 
the  spine  of  the  seventh  cervical  vertebras  from  the  ground. 

A  skeleton  may  be  identified  as  that  of  some  particular 
person  many  years  even  after  death  through  the  presence 
of  deformities,  fractures,  callus,  etc.  The  production  of 
callus  is  the  result  of  the  reparative  process  that  takes  place 
in  the  case  of  fractured  bones,  and  its  presence  proves  that 
some  time  must  have  elapsed  between  the  time  of  fracture 
and  death.  The  absence  of  such  callus  in  cases  of  death 
following  fractures  would  clearly  indicate  that  death  fol- 
lowed soon  after  the  injury  causing  the  fracture,  and  that 
in  the  case  of  fracture  of  the  skull  the  injury  was  the  cause 
of  death.  Under  certain  circumstances  it  may  become  a 
matter  of  importance  to  determine  from  an  examination  of 
the  skeleton  alone  the  length  of  time  that  the  body  has 
been  buried.  It  may  be  said  that  ordinarily  within  ten 
years  after  burial  the  soft  parts  of  a  body  entirely  disap- 
pear; the  bones,  however,  may  resist  decomposition  for 
thirty  or  forty  years,  particularly  if  the  surrounding  soil 
is  dry.  It  is  well  known,  however,  that  the  skeletons  of 
individuals  buried  in  leaden  or  in  stone  coffins  have  been 
found  in  a  tolerable  state  of  preservation  even  after  a  lapse 
of  more  than  a  thousand  years. 

Medical  Witnesses  at  the  Inquest. — After  the  coroner 
has  held  his  inquest,  and  the  coroner's  physician  and  the 
witnesses  have  given  their  testimony,  and  the  jury  sub- 
mitted their  verdict,  the  defendant,  in  case  of  the  verdict 
being  guilty,  is  then  remanded  to  the  district  attorney's 
office.     The  case  then  comes  up  before  the  grand  jury,  to 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         49 

which  the  coroner's  physician  slates  substantially  what  he 
has  already  said  at  the  coroner's  inquest.  If  the  grand 
jury  finds  a  true  bill  the  case  then  goes  to  court;  the  trial 
is  set  for  a  certain  day,  is  finally  held,  and  the  coroner's 
physician  is  subpoenaed  for  the  third  time  to  appear  in 
court. 

If  the  court  is  aware  that  the  coroner's  physician  or  any 
of  the  medical  experts  engaged  in  the  case  have  large 
practice  or  are  connected  as  lecturers  with  any  particular 
medical  schools,  etc.,  it  is  very  considerate,  as  a  general 
rule,  arranging  its  business  so  as  to  inconvenience  them  as 
little  as  possible.  It  is  incumbent,  however,  upon  the 
physician,  whether  he  be  the  coroner's  physician  or  retained 
as  an  expert  for  the  defence,  to  treat  the  court  with  every 
possible  respect,  to  be  always  punctual  in  attendance,  and 
if  he  be  unavoidably  delayed  by  professional  exigencies, 
to  send  the  court  word  explaining  the  cause  of  non-attend- 
ance. The  court,  however,  will  not  submit  to  any  of  the 
physicians  subpoenaed  straggling  in  at  any  hour  of  the  day 
with  no  excuse  to  offer  for  their  non-attendance  but  de- 
tention by  their  every-day  practice. 

Conduct  of  Medical  Witnesses  in  Court. — At  the  trial, 
the  medical  witness,  if  he  be  the  coroner's  physician,  is 
examined  first  by  the  prosecution,  by  the  district  attorney. 
Having  given  testimony,  he  is  cross-examined  by  the 
counsel  for  the  defence,  and  is  then  usually  re-examined 
by  the  district  attorney,  and  here  as  a  rule,  the  ex- 
amination ends.  In  giving  evidence  in  court,  the  medi- 
cal witness  should  always  maintain  a  dignified,  composed 
demeanor.  He  should  never  be  arrogant  or  show  any 
irritability,  still  less  lose  his  temper,  however  much  he 
may  be  annoyed  by  the  examination  or  cross-examina- 
tion. He  should  never  forget  that  the  object  of  the 
4 


50  A    MANUAL   OF 

prosecution  is  to  elicit  all  the  evidence  that  will  lead  to 
conviction  ;  the  object  of  the  defence  to  try  to  rebut,  break 
down  all  that  the  prosecution  hopes  to  establish.  The 
medical  witness  should  so  answer  that  he  can  be  heard  by 
the  whole  court,  addressing  himself  more  particularly  to 
the  jury.  His  answers  should  be  brief  and  given  in  the 
simplest  language,  all  technical  terms  being  avoided  as 
much  as  possible.  Finally,  the  medical  witness  should 
never  be  ashamed  of  saying  in  open  court  that  he  does  not 
know.  The  court  does  not  expect  the  medical  witness  to 
know  everything.  Nothing  is  more  foolish  for  a  witness 
than  to  hazard  a  guess  in  answer  to  a  question  for  fear  of 
being  thought  ignorant. 

Dying  declarations,  it  may  be  mentioned  in  this  con- 
nection, are  accepted  in  law  as  evidence  without  being 
sworn  to.  It  is  naturally  presumed  that  all  statements 
made  at  such  a  solemn  crisis  must  be  sincere,  believed  at 
least  to  be  true  by  the  dying  person  even  if  subsequently 
shown  not  to  be  so.  The  attending  physician  under  such 
circumstances  having  expressed  the  opinion  that  the  patient 
is  dying  and  in  sound  mind,  a  magistrate  should  be  sum- 
moned to  take  down  any  statements  that  the  dying  person 
may  wish  to  make.  Should  it  not  be  possible  to  obtain 
the  services  of  a  magistrate,  then  the  attending  physician 
can  take  down  the  dying  declarations.  The  physician 
should,  however,  limit  himself  to  writing  down  the  exact 
words  of  the  dying  person  without  offering  any  interpre- 
tation whatever.  The  statement  should  be  read  over  to 
the  dying  person  and  if  possible  his  signature  to  it 
obtained. 


MEDICAL   JUKLSritUDENCE   ANJ)   TOXICOLOGY.         51 


CHAPTER  IV. 

Medico-legal  Definition  of  Wounds — Comparison  of  Wounds  with 
Weapon  inflicting  them  and  Clothes  of  Deceased  — Incised,  Contused, 
Penetrating  Wounds — Suicidal,  Homicidal,  Accidental  Wounds — 
Gunshot  Wounds — Causes  of  Death  from  Wounds. 

Medico-Legal  Definition  of  Wounds. — A  wound,  from  a 
purely  surgical  point  of  view,  is  regarded  as  a  solution 
of  continuity  of  the  soft  parts  occasioned  by  external  vio- 
lence. The  medico-legal  idea  of  a  wound  is,  however, 
far  more  comprehensive,  embracing  all  injuries  of  the 
body,  external  or  internal,  with  or  without  a  solution  of 
continuity  of  the  skin,  produced  suddenly  by  external 
violence.1  As  the  danger  of  a  wound  will  depend  on 
the  age  and  constitution  of  the  person,  its  position,  the 
weapon  by  which  it  was  inflicted,  the  amount  of  hemor- 
rhage, and  numerous  other  circumstances,  it  is  impossible 
for  a  physician  to  state  positively  whether  a  wound  will 
prove  fatal  or  not.  Wounds  at  first  apparently  trivial 
have  subsequently,  in  many  cases,  as  is  well  known,  been 
the  cause  of  death.  The  medical  witness  should,  therefore, 
express  himself  most  cautiously  if  he  replies  at  all  to  the 
questions  so  often  asked,  "  Will  such  a  wound  prove  fatal?" 
"  Was  such  a  wound  necessarily  mortal  ?" 

In  making  a  post-mortem  examination  in  cases  where 
death  is  due  to  wounds,  it  is  most  important  that  the 
medical  examiner  should  satisfy  himself,  not  only  that  the 
wound  was  the  cause  of  death,  but  also  that  the  remainino; 
organs  were  healthy,  or  at  least  were  not  in  such  a  condi- 
tion that  death  could  be  attributed  in  any  way  to  them,  or 

1  Beck,  T.  B.  and  J.  B. :  Elements  of  Medical  Jurisprudence,  eleventh 
edition,  Philadelphia,  1860,  p.  282. 


52 


A   MANUAL  OF 


to  any  other  cause  than  the  one  assigned.  On  more  than 
one  occasion  has  the  defendant  been  acquitted  owing  to 
such  neglect,  giving  rise  in  the  minds  of  the  jury  to  the 
doubt  as  to  whether  disease  or  the  wound  was  the  real 
cause  of  death.  On  the  other  hand,  as  in  a  celebrated 
case,  the  defendant  would  have  been  convicted  of  murder, 
it  being  in  evidence  that  the  deceased,  a  young  girl,  had 
received  from  him  a  severe  beating,  had  not  the  true  cause 
of  death,  the  poison  taken,  been  well  established  by  the 
medical  examination.1 

In  cases  of  death  from  wounds  the  medical  examiner 
should  carefully  note  their  exact  situation,  direction,  and 

Fig.  9. 


'V' 

".  ~yi 


m 


Human  hair.  1.  The  hair  of  a  child. 
2.  Hair  of  an  adult.  3.  Pointed  ex- 
tremity of  the  hair  of  the  eyebrow. 
a.  Transverse  section  of  the  hair  showing 
the  cortical  and  medullary  portion,  and 
air-cells  in  the  centre  of  the  cylinder. 


Human  hair  with  the  tubu- 
lar sheath  as  torn  out  by  force. 


extent.     If  the  weapon  by  which  the  wounds  were  known 

or  supposed  to  have  been  inflicted  has  been  obtained,  it 

1  Wharton  and  Stille:  op.  cit.,  vol.  iii.  p.  216. 


MEDICAL  JURISPRUDENCE   AND  TOXICOLOGY 


53 


should  bo  compared  by  the  medical  examiner  with  the 
wounds  themselves,  so  that,  on  subsequent  examination,  he 
can  positively  state  whether  such  wounds  as  were  found 
could  have  been  inHicted  by  the  weapon  submitted.  The 
clothes  of  the  deceased  should  be  carefully  inspected,  and 
any  rents,  cuts,  or  tears  found  compared  with  the  wounds 
in  the  body  and  with  the  weapon  by  which  they  were  in- 


Fig.  10. 


Fig.  11. 


Microscopic  appearance  of  hairs  of 
various  animals.  1.  Hair  of  the  span- 
iel. 2.  Hair  or  fur  of  the  rabbit.  3. 
Hair  of  the  hare.  4.  Hair  of  the 
horse.  5.  Hair  of  the  goat.  6.  Hair 
of  the  fox.  7.  Hair  of  the  cow.  8, 
Hair  of  the  fallow  deer. 


1.  Cotton.— a.  normal  condition:  b, 
portion  treated  with  sulphuric  acid 
and  iodine;  c,  fragment  of  gun-cotton. 

2.  Flax— a,  normal  fibre  ;  6,  portion 
boiled  with  nitric  acid  ;  c,  treated  with 
nitric  acid,  and  afterwards  with  sul- 
phuric acid  and  iodine. 


flicted.     Hairs  and  fibres  found  upon  the  weapon  supposed 
to  have  inflicted  the  fatal  wound,  or  upon  the  person  of 


54  A    MANUAL   OF 

the  accused,  should  be  examined  with  the  microscope  and 
compared  with  those  of  the  clothing  worn  by  the  deceased. 

As  a  general  rule,  human  hairs  (Fig.  9)  can  readily  be 
distinguished  from  those  of  animals,  or  from  fibres  of 
cotton,  silk,  wool,  etc.  The  hairs  of  the  lower  animals, 
some  of  which  are  represented  in  Figure  10,  differ  in 
many  respects  from  those  of  man,  being  generally  coarser, 
thicker,  shorter,  and  less  transparent.  Microscopically,  the 
most  striking  differences  in  hairs  are  presented  by  the  cells 
and  linear  markings  of  their  cortical  portions.  The  fibres 
of  cotton  (Fig.  11,  l)  are  flattened  bands  disposed  in  a  spiral 
or  twisted  manner.  Those  of  linen  (Fig.  11,  2)  are  rectili- 
near, tapering  to  a  point  and  presenting  pointed  markings 
at  unequal  distances.  Silk  fibres  are  cylindrical  in  shape, 
almost  entirely  free  from  markings,  and  refract  light  power- 
fully. The  fibres  of  wool  are  rather  irregular  in  form  and 
unequal  in  thickness. 

The  importance  of  making  a  thorough  post-mortem  ex- 
amination in  cases  of  death  from  violence  is  well  shown 
in  cases  of  persons  crushed  to  death,  as  by  a  heavily-loaded 
wagon.1  It  is  well  known  that,  although  the  external  signs 
of  violence  in  such  cases  may  be  limited  to  a  few  abrasions, 
the  internal  injuries  causing  death  may  be  of  the  most  ex- 
tensive and  serious  character. 

Character  of  Wounds. — Wounds  are  usually  described 
as  being  incised,  lacerated,  contused,  punctured,  or  pene- 
trating. Incised  wounds  may  generally  be  recognized  by 
the  regularity  and  evenness  of  the  cut;  and  it  might  natu- 
rally be  supposed  that  they  would  be  made  by  cutting 
weapons,  penetrating  wounds  being  supposed  to  be  inflicted 
by  pointed  instruments,  and  contused  wounds  by  blunt  ones. 
It  must  be  admitted,  however,  that  in  certain  cases,  as  in 
1  Casper  :  op.  cit.,  vol.  i.  p.  112,  case  xl. 


MEDICAL    JURISPRUDENCE    AND   TOXICOLOGY.         55 

wounds  inflicted  by  broken  glass  or  china,  which  resemble 
exactly  incised  wounds,  it  might  be  very  difficult  to  Bay 
how  the  wounds  had  been  made.  Indeed,  it  is  impossible 
for  the  medical  examiner,  though  often  asked,  to  state 
positively  whether  a  wound  was  inflicted  with  a  particular 
kind  of  weapon. 

Suicidal  Wounds. — It  often  becomes  important  to  deter- 
mine whether  a  wound  was  inflicted  before  or  after  death. 
In  the  case  of  an  incised  wound  this  is  not  very  difficult, 
since,  if  made  before'  death,  the  edges  of  the  wound  are 
everted  and  are  more  or  less  filled  with  coagulated  blood, 
principally  of  an  arterial  character,  or  with  granulations, 
pus,  or  sloughs,  if  any  length  of  time  has  elapsed  before 
death.  Contused  wounds,  if  made  during  life,  are  char- 
acterized by  ecchymoses,  suggillation,  or  the  black-and- 
blue  discoloration  due  to  the  rupture  of  small  vessels,  and 
the  effusion  of  blood  into  the  cellular  tissue  under  the 
skin.  The  progressive  changes  of  color — purple,  black, 
violet,  green,  yellow — exhibited  by  ecchymoses  serve  not 
only  to  indicate  whether  the  bruise  was  made  before  or' 
after  death,  but  also  as  to  the  length  of  time  elapsing 
since  its  production.  Thus,  for  example,  within  twelve 
hours  after  the  injury,  and  in  some  cases  immediately 
afterward,  the  color  presented  by  the  bruise  is  that  of  a 
purplish-black ;  by  the  third  day  it  has  become  violet ; 
by  the  fifth  or  sixth  day,  green ;  and  by  from  the 
eighth  to  the  tenth  day,  yellow.  The  latter  color  grad- 
ually disappears  by  from  the  twelfth  to  the  fourteenth 
day,  the  skin  reassuming  its  natural  hue  and  presenting 
no  trace  of  the  discoloration.  The  situation,  extent,  and 
direction  of  a  wTound  and  the  position  in  which  the 
weapon  was  found  should  most  carefully  be  observed 
and  noted   by  the  medical  examiner,  as  it  may  become 


56  A    MANUAL   OF 

essential  under  certain  circumstances  to  determine  whether 
the  wound  was  suicidal,  homicidal,  or  accidental.1  In 
cases  of  persons  taking  their  own  lives,  the  mouth,  fore- 
head, the  region  over  the  heart,  etc.,  are  usually  chosen  if 
fire-arms  were  used ;  the  throat  or  heart  if  the  wounds 
were  inflicted  with  cutting  instruments.  While  ordinarily 
accessible  parts  of  the  body  are  selected  by  suicides,  it 
must  not  be  forgotten  that  insane  persons,  in  committing 
suicide,  have  inflicted  wounds  upon  themselves  in  most  in- 
accessible parts,  such  as  the  back  of  the  head  and  neck. 
It  is  well  known  that  insane  persons  have  killed  them- 
selves by  falling  backwards,  their  heads  striking  upon  some 
hard  substances,  or  by  shooting  themselves  through  the 
back  of  the  head.  The  fact  of  a  person  being  found  dead 
shot  through  the  back  of  the  ear  might  suggest  that  the 
wound  was  homicidal.  It  would  not,  however,  prove  it ; 
since  it  is  well  known  that  insane  persons  have  taken  their 
lives  in  that  very  way.  Incised  wounds  of  the  throat,  es- 
pecially if  the  direction  of  the  wound  be  from  left  to  right, 
the  deceased  being  right-handed,  are  usually  regarded  as 
presumptive  of  the  death  being  suicidal. 

Homicidal  Wounds. — It  should  be  remembered  that  a 
very  common  way  of  committing  murder  is  by  cutting 
the  throat  of  the  victim,  the  murderer  standing  behind ; 
a  wound  inflicted  in  such  a  manner  would  resemble  that 
committed  by  a  suicide.  On  the  other  hand,  the  irregu- 
larity of  the  wound  often  observed  in  such  cases,  and 
sometimes  submitted  as  a  proof  that  the  wound  was  homi- 
cidal, and  attributable  to  the  resistance  offered  by  the 
deceased  in  his  struggle  for  life,  might  just  as  well  be  ac- 
counted for  on  the  supposition  that  it  was  suicidal  and  due 

1  Casper :    Gerichtliche  Leichen   CEffnungen,  Erstes   Hundert,  Berlin, 
1853,  S.  17. 


MEDICAL    JURISPRUDENCE    AND    TOXICOLOGY.         57 

to  the  nervousness  and  indecision  of  the  deceased.  A 
homicidal  can  usually  be  distinguished  from  a  suicidal 
wound  by  its  direction.  Tims,  for  example,  if  a  man 
were  found  dead  with  a  wound  in  the  neck  of  such  a  char- 
acter that  it  could  be  positively  stated  that  the  weapon  had 
been  partially  turned  and  withdrawn,  and  again  plunged 
into  the  neck  in  a  different  direction,  as  is  sometimes  done 
by  German  butchers,1  the  proof  would  be  strong  of  the 
wound  being  homicidal.  Or,  if  the  nature  of  the  wound 
in  the  neck  indicated  that  it  had  been  made  by  cutting 
from  within  outward,  as  is  often  done  by  English  butchers 
in  the  killing  of  sheep,  it  would  be  strong  presumptive 
evidence  that  murder  had  been  committed. 

Accidental  wounds  are  usually  found  in  such  parts  of 
the  body  as  are  exposed.  If  wounds,  the  nature  of  which 
might  otherwise  lead  to  the  supposition  that  they  had 
been  made  accidentally,  are  found  upon  both  sides  of  the 
body,  the  presumption  would  then  be  that  they  were 
homicidal. 

Gunshot  wounds  are  essentially  contusions.  Owing, 
however,  to  the  vitality  of  the  parts  struck  being  destroyed 
by  the  projectile,  there  ensues  a  process  of  sloughing.  In 
this  respect  gunshot  wounds  differ  from  ordinary  wounds. 
They  differ  very  much  in  appearance,  according  to  the 
nature  of  the  projectile,  to  the  distance  from  which  the 
piece  was  discharged,  etc.  As  a  general  rule  the  hemor- 
rhage following  a  gunshot  wound  is  not  very  great,  unless 
some  of  the  large  vessels  are  wounded.  It  should  be 
mentioned,  however,  that  though  the  external  hemorrhage 
may  not  be  very  great,  owing  to  the  form  and  size  of  the 
wound,  the  internal  hemorrhage  may  be  so  severe  as  to 
prove  fatal.  If  the  weapon  be  in  close  proximity  to  the 
1  Kopp's  Jakrbucher,  Erster  Jahrgang,  180S,  S.  143. 


58  A    MANUAL  OF 

body  at  the  moment  that  it  was  discharged,  the  wound 
made  is  large,  the  skin  is  denuded,  blackened,  and  partly 
burned.  The  hair  or  the  clothes  are  also  usually  scorched. 
The  orifice  of  entrance  of  the  missile,  if  it  be  a  ball,  is 
depressed  and  larger  than  that  of  the  exit  orifice.1  The 
character  of  the  entrance  orifice  of  the  wound  will  depend 
upon  the  shape  of  the  missile,  the  velocity  with  which  it 
was  travelling,  and  the  distance  from  which  it  was  fired. 
Thus,  a  wound  made  by  a  conoidal  ball,  like  that  of  a 
minie  rifle,  is  linear  in  form.  Such  a  wound  produces  but 
little  external,  though  considerable  internal,  injury.  On 
the  other  hand,  the  wound  made  by  a  rifle  ball  is  ragged 
and  large.  A  ball  after  entering  the  body  may,  as  is  well 
known,  be  so  deflected  from  its  course  by  striking  a  bone 
or  a  tendon,  etc.,  as  to  pass  entirely  around  the  body  and 
so  reach  finally  the  point  of  entrance.  If  a  gunshot  wound 
be  caused  by  a  load  of  shot,  the  appearance  presented  will 
depend  upon  the  distance  from  which  the  shot  was  fired. 
If  the  weapon  discharged  be  within  twelve  inches  of  the 
body,  the  wound  will  usually  be  a  single  one.  Beyond 
that  distance  each  shot  will  make  a  single  individual 
wound.2  It  should  be  mentioned  that  a  single  shot 
might  cause  death,  as  in  the  case  of  the  wounding  of 
the  aorta.  Serious,  if  not  fatal,  wounds  may  be  caused  by 
wadding  and  gunpowder  alone  if  the  weapon  be  within 
three  or  four  inches  of  the  body. 

Causes  of  Death  from  Wounds. — With  reference  to  the 
committing  of  suicide  by  means  of  fire-arms,  it  may  be 
mentioned   that  in  fully  four- fifths  of  the  cases  reported 

1  According  to  some  authorities,  the  exit  is  larger  than  the  entrance 
orifice  (compare  Casper,  vol.  i.  p.  266;  Woodman  and  Tidy,  p.  1115; 
Wharton  and  Stille,  vol.  iii.  p.  234). 

2  Lachese  :  Annates  de  Hygiene publique,  Paris,  1836,  p.  359;  Casper: 
op.  cit.,  vol.  i.  p.  266. 


MEDICAL    JURISPRUDENCE    AND   TOXICOLOGY.         ■>■> 

the  part  of  the  body  selected  for  the  infliction  <>f  tlic 
wounds  was  the  head,  the  mouth  being  the  part  more  par- 
ticularly chosen.1  Under  certain  circumstances  it  may 
become  important  for  the  medical  examiner  to  be  able  to 
state,  in  the  case  of  death  from  wounds,  the  real  cause  of 

Fig.  12. 


Imaginary  lines  drawn  upon  the  surface  of  the  abdomen,  dividing  it  into 
regions.  These  were,  no  doubt,  devised  by  reason  of  the  absence  of  any  charac- 
teristic eminences  or  depressions  upon  this  extensive  surface,  principally  attrib- 
utable to  the  absence  of  any  skeleton,  osseous  or  cartilaginous.  1.  Right  hypo- 
chondriac region.  2.  Epigastric.  3.  Left  hypochondriac.  4.  Right  lumbar. 
5.  Umbilical.    G.  Left  lumbar.    7.  Right  iliac.    S.  Hypogastric.    9.  Left  iliac. 

death,  whether  immediate  or  remote.  The  immediate 
cause  of  death  from  a  wound  is  either  hemorrhage  or 
shock,  the  latter  being  the  result  of  a  powerful  impression 
made  upon  the  nervous  ceutres.  Of  the  remote  causes 
of  death  from  wounds  the  most  common  are  tetanus  or 
1  De  Boismont :  Du  Suicide,  deuxieme  edition,  Paris,  1865,  p.  681. 


60  A  MANUAL  OF 

lock-jaw,  erysipelas,  hospital  gangrene,  surgical  opera- 
tions, including  the  use  of  ether  or  chloroform.  The 
danger  of  wounds  depends,  to  a  great  extent,  upon  the 
parts  of  the  body  affected.  Thus  scalp  wounds  are  not 
usually  dangerous  unless  followed  by  erysipelas.  It  should 
be  remembered,  however,  in  cases  of  wounds  of  the  head, 
that  a  fracture  or  effusion  of  blood  upon  the  brain,  or  con- 
cussion, may  be  produced  by  a  blow,  even  though  the  scalp 
be  uninjured.  It  is  most  important  that  the  effects  of 
concussion  should  not  be  mistaken  for  those  of  intoxica- 
tion. Unfortunately  in  too  many  instances  persons  arrested 
upon  the  charge  of  intoxication  have  died  in  station-houses 
from  concussion  of  the  brain,  when  their  lives  might  have 
been  saved  had  medical  attendance  been  summoned. 

Wounds  of  the  face  are  not  usually  dangerous  unless  the 
orbit  be  involved,  as  in  penetration  of  the  orbital  plate  by 
the  point  of  an  umbrella  thrust  into  the  face.  The  danger 
of  wounds  of  the  neck  is  due  to  the  presence  of  the  great 
vessels,  the  division  of  which,  in  case  of  the  throat,  gives 
rise  to  severe  hemorrhage.  The  trachea  and  larynx  may 
be  divided,  however,  without  necessarily  proving  fatal, 
unless  the  blood  flows  into  the  trachea  in  such  quantity 
as  to  cause  death.  Death  from  wounds  of  the  chest  is 
usually  due  to  hemorrhage  from  the  heart,  lungs,  or  great 
vessels.  In  cases  of  wounds  of  the  abdomen,  involving  the 
liver,  stomach,  or  intestines  (Fig.  12, 1 , 2, 3),  the  cause  of  death 
is  frequently  peritonitis.  With  regard  to  wounds  of  the  blad- 
der (Fig.  12,  8)  it  must  be  borne  in  mind  that,  if  distended,  it 
may  readily  be  ruptured  by  a  blow  upon  the  abdomen, 
the  cause  of  death  being  usually  peritonitis.  Frequently, 
however,  under  such  circumstances,  there  may  be  no  signs 
of  external  injury.  In  wounds  of  the  spine  the  danger  is 
proportional  to  the  extent  to  which  the  spinal  cord  is  in- 


MEDICAL   JDE18PRUDENCB   AND  TOXICOLOGY.        61 

volved,  death  taking  place  instantaneously  if  the  medulla 
or  upper  portion  of  the  spinal  cord  be  wounded.  The 
danger  in  wounds  of  the  generative  organs  is  due  to  the 
severe  hemorrhage  which  usually  ensues.  In  the  male 
sex,  in  the  case  of  the  insane,  castration  and  amputation 
of  the  penis  arc  frequently  self-inflicted. 


62  A   MANUAL   OF 


CHAPTER  V. 

Blood-stains — Chemical,  Microscopical,  Spectroscopical  Methods  of 
Investigation — Coagulation  of  Blood — Conditions  Influencing  Coag- 
ulation. 

Not  unfrequently,  in  cases  of  murder,  it  becomes 
necessary  to  determine  if  certain  dark  stains,  such  as  are 
found  on  a  knife,  linen,  underwear,  pieces  of  wood,  etc., 
were  made  by  blood.  The  appearance  presented  by  blood- 
stains will  vary  according  to  their  size,  shape,  and  color. 
Usually  the  stain  consists  of  distinct  spots ;  it  may,  how- 
ever, be  a  mere  streak  or  film.  The  color  of  recent  blood- 
stains is  red,  that  of  old  ones  brown  or  brownish-red.  It 
will  be  more  or  less  modified  according  to  the  nature  of  the 
material  upon  which  the  blood  has  fallen.  Thus  the  color 
of  blood  upon  soft  wood,  linen,  or  cloth  is  dark ;  that  upon  a 
polished  metallic  surface  is  shining,  the  spots  presenting  in 
the  latter  case  cracks  radiating  from  the  centre.  There  are 
three  methods  of  examining  stains  supposed  to  have  been 
made  by  blood,  the  chemical,  the  microscopical,  the  spec- 
troscopical, all  of  which,  on  account  of  the  importance  of 
the  subject,  merit  at  least  a  brief  description. 

The  chemical  method  of  investigation  is  based  upon  the 
fact  that  the  haemoglobin  of  the  blood  is  soluble  in  cold 
water.  If  the  suspected  blood-stain  is  in  sufficient  quan- 
tity and  not  so  old  that  the  haemoglobin  has  been  con- 
verted into  hsematiu,  by  proper  manipulation  a  solution 


MEDICAL   JUEISPEUDENCE    AND   TOXICOLOGY.        63 

of  the  coloring  matter  of  the  blood  can  be  obtained  and 
then  tested.  If  the  article  stained  be  a  linen  shirt,  for 
example,  a  small  piece  should  be  cut  out  and  suspended 
in  a  test-tube  containing  cold  distilled  water.  In  a  few 
minutes,  or  longer,  if  the  stain  be  an  old  one,  the  color- 
ing matter  of  the  blood  will  pass  into  the  water,  color- 
ing it  red.  If  the  stained  material  to  be  examined  is 
attached  to  wood  or  a  knife-blade,  it  must  be  scraped 
or  cut  off  and  then  soaked  in  water.  Should  the  solu- 
tion be  not  complete,  a  trace  of  citric  acid  or  a  little 
ammonia  may  be  added,  the  latter  not  affecting  the  color 
of  the  solution.  The  solution  so  obtained  should  then 
be  heated  in  a  test-tube  over  a  spirit-lamp.  If  the  solu- 
tion be  that  of  the  coloring  matter  of  the  blood,  it  will 
coagulate,  the  red  color  will  disappear,  and  a  brownish- 
green  material  will  be  precipitated.  In  this  way  a  solution 
of  the  coloring  matter  of  the  blood  may  usually  be  dis- 
tinguished from  other  red  solutions,  such  as  those  of  red 
prints,  logwood,  kino,  madder,  cochineal,  which  do  not 
coagulate  when  heated,  and  which  change  their  color  when 
ammonia  is  added. 

Stains  made  by  red  paint  or  by  lemon-juice  on  iron, 
while  slightly  resembling  blood-stains,  can  be  distinguished 
from  the  latter  through  their  color  becoming  a  bluish, 
inky  black  on  addition  of  tincture  of  galls,  ferro-cyanide 
of  potassium,  or  by  other  tests  for  iron.  Another  test  for 
blood,  that  known  as  the  guaiacum  test,  is  based  upon  the 
fact  that  the  resin  of  guaiacum  when  oxidized  assumes  a 
sapphire-blue  color,  and  that  this  change  in  the  color  of 
the  resin  can  be  induced  by  the  addition  of  blood  and  per- 
oxide of  hydrogen  together,  but  not  by  the  addition  of 
blood  alone.     A  convenient  way  of  applying  the  guaiacum 


64  A   MANUAL  OF 

test,  frequently  made  use  of  by  the  writer,  is  to  add  a  few- 
drops  of  a  freshly-prepared  tincture  of  guaiacum  to  a 
small  quantity  of  water,  by  which  the  resin  is  precipitated. 
The  water  holding  the  resin  in  suspension  is  then  divided 
into  three  portions.  To  the  first  portion  a  few  drops  of 
peroxide  of  hydrogen  dissolved  in  ether  are  added  ;  to  the 
second  portion  a  few  drops  of  the  solution  supposed  to  con- 
tain the  coloring  matter  of  the  blood.  In  neither  case 
will  any  change  in  the  color  of  the  resin  be  observed. 
Now  to  the  third  portion  add  a  few  drops  of  the  suspected 
solution  and  of  the  etherized  peroxide,  and  at  once  the  resin 
will  assume  a  sapphire-blue  color.  Should  the  solution  be 
turbid  through  excess  of  the  resin,  a  few  drops  of  alcohol 
will  instantly  clear  it.  It  should  be  mentioned  in  this 
connection  that  the  resin  of  guaiacum  in  the  presence  of 
peroxide  of  hydrogen  is  oxidized,  turns  blue  by  the  ad- 
dition of  bile,  saliva,  red  wine,  as  well  as  by  blood.  The 
color  of  bile  and  saliva,  however,  should  serve  to  dis- 
tinguish these  secretions  from  blood,  while  in  the  case  of 
red  wine  several  hours  are  required  to  produce  the  blue 
color  in  the  resin.  It  will  be  observed  that  the  existence 
of  blood  is  not  directly  proved  by  the  chemical  tests  just 
described,  but  is  inferred  from  the  presence  of  its  coloring 
matter  or  haemoglobin,  and  in  most  cases  is  only  pre- 
sumptively established. 

The  microscopic  method  of  proving  the  existence  of 
blood  depends  on  the  ability  of  the  examiner  to  treat 
the  material  submitted  to  him  in  such  a  way  that  if  it 
be  blood  the  corpuscles,  and  more  especially  the  red  ones, 
may  be  sufficiently  restored  to  admit  of  identification 
under  the  microscope,  or  at  least  to  enable  him  to  obtain 
the  crystalline  forms  developed  through  changes  in  their 
coloring  matter.     The  separation  of  the  corpuscles  from  a 


MEDICAL    JUIUSI'KUDKNCK    AND    TOXICOLOGY.         GO 

material  consisting  of  pieces  of  linen,  wood,  or  iron  stained 
witli  blood  mixed  with  dirt,  etc.,  is  a  far  more  difficult 
operation,  however,  than  that  of  demonstrating  simply  the 
presence  of  blood-crystals.  If  the  material  submitted  for 
examination  is  a  piece  of  linen,  for  example,  stained  with 
what  is  supposed  to  be  blood,  a  piece  of  it  should  be  cut 
out  and.  placed  upon  a  clean  glass  slide  and  moistened  with 

Fig.  13. 

©  ^ 

Blood-Corpuscles  (X  450). 

a  solution  consisting  of  one  part  of  glycerine  to  seven 
of  water,  or  with  a  solution  of  common  salt  having  a 
specific  gravity  of  that  of  the  serum  of  the  blood.  The 
specimen  should  then  be  covered  with  a  thin  cover-glass 
and  examined  with  the  microscope.  By  this  method,  if 
the  stain  be  blood,  and  not  too  old,  the  red  blood-corpus- 
cles and  sometimes  the  white  ones  as  well  will  be  usually 
brought  into  view.  If  the  material  suspected  to  be  blood 
is  in  the  form  of  a  clot,  on  a  knife-blade,  for  example,  a  small 
portion  of  it  should  be  scraped  off  with  a  needle  on  to  a 
perfectly  clean  glass  slide.  A  thin  cover-glass  being  pressed 
firmly  down  on  the  fragment  until  it  is  reduced  to  powder, 
the  glass  slide  is  then  placed  upon  the  stage  of  the  micro- 
scope. A  drop  of  distilled  water  being  allowed  to  flow  slowly 
from  the  margin  of  the  cover-glass  toward  the  powdered 
material,  if  the  latter  be  blood  the  corpuscles  will  gradually 
make  their  appearance,  and,  although  faint  and  colorless, 
5 


66  A    MANUAL   OF 

are  usually  sufficiently  definite  in  outline  to  admit  of 
identification. 

A  red  blood-corpuscle  of  man  (Fig.  13),  as  seen  in 
freshly-drawn  blood,  may  be  described  as  a  biconcave 
disk,  a  mass  or  cell  of  protoplasm  without  a  cell  wall 
or  nucleus,  and  with  a  diameter  in  its  greatest  width  on 
an  average  of  -g-^o^-th  °f  an  inch. 

Micrometer. — Inasmuch  as  there  are  obtained  from  sup- 
posed blood-stains  certain  bodies  having  the  size  just  men- 
tioned, and  as  this  is  usually  regarded  as  one  of  the  strong- 
est proofs  that  such  bodies  are  red  blood -corpuscles,  the 
method  by  which  they  are  measured  must  be  described. 
The  instrument  used  for  this  purpose  by  the  microsco- 
pist-is  an  eye-piece  micrometer,  that  is,  an  eye-piece 
upon  the  glass  of  which  have  been  ruled  a  number  of 
parallel  and  equidistant  lines,  which,  on  being  projected 
upon  the  field  of  the  microscope,  will  be  seen  by  the  ob- 
server to  cover  any  objects  visible  there  and  to  define  their 
limits.  To  use  the  eye-piece  micrometer,  the  value  of  the 
spaces  between  the  lines  must  be  determined  for  the  par- 
ticular magnification,  since  these  will  vary  with  the  ob- 
jective 'and  the  length  of  tube  used.  To  accomplish  this, 
there  is  placed  upon  the  stage  of  the  microscope  a  glass 
slide  upon  which  have  been  ruled  a  number  of  parallel 
lines  separated  from  one  another  by  distances  of  y^th, 
r^¥th,  and  y^g-ffth  °f  an  mcn  respectively  (Fig.  14).  Let 
us  suppose,  for  example,  that  the  magnifying  power  used 
is  such  that  ten  lines  of  the  eye-piece  micrometer  corre- 
spond exactly  to  the  space  between  two  of  the  lines  upon 
the  stage  micrometer  that  are  separated  by  ygVffth  of  an 
inch,  the  value  of  the  spaces  between  the  lines  of  the  eye- 
piece micrometer  will  be  then  equal  to  jowoth  °f  an  mcn, 
and  an  object  covered  by  four   such   spaces  as  a  white 


MEDICAL    .lUKLSl'UUDENCK    AND    TOXICOLOGY. 


67 


corpuscle  (Fig.  14,  W)  would  have  a  diameter  therefore  of 
rTr$"o~o*n  ~  tsW^  °^  an  'n<;^-  ft  is  obvious,  however, 
that  with  such  magnification  a  red  blood-corpuscle,  if  its 
diameter  be  s^V^1  °f  au  inch,  will  be  covered  by  less  than 
four  such  spaces,  and  by  more  than  three,  since  -^Vo^1  °^ 
an  inch  is  less  than  ^  q  ft  q  ^ th  and  more  than  xTTolTTr^1  °^'  an 
inch.  As  the  red  corpuscles,  in  order  to  be  measured, 
must  lie  within  the  space  between  two  lines  the  value  of 
which  is  known,  and  further,  as  the  edges  of  the  corpuscle 
must  be  exactly  in  contact  with  the  two  lines  circum- 
scribing  it,  an   object-glass  and  length  of  tube  must  be 


Fig.  14. 


R 

HI 

W 

P.l 

HI!  Mill 


Lines  of  Eye-Piece  Micrometer,  projected  upon  Stage  Micrometer,  as  seen  with 
different  magnification. 


used  so  that  exactly  32  lines  of  the  eye-piece  micrometer 
can  be  counted  within  a  space  of  y^-th  of  an  inch,  as  each 
space  will  then  be  equal  to  sY^th  °f  an  iucn>  and  will 
exactly  cover  the  red  corpuscles  (Fig.  14,  R). 

Such  a  simple  micrometric  arrangement  as  that  just 
described  (Fig.  14)  will  suffice  for  determining  whether 
bodies  supposed  to  be  red  corpuscles  have  an  average 
diameter  of  g^-Q-th  of  an  inch,  and,  approximately  at 
least,  the  diameter  of  larger  or  smaller  bodies.  It  is 
obvious,  however,  that  if  the  body  to  be  measured  was 


300 


Q-th  of  an  inch  in  diameter,  in  order  to  measure  it 


the 

accurately  the  magnification  (Fig.  14)  would  have  to  be 
so  altered  that  the  space  of  the  yFotn  of  an  inch  would 
contain   exactly  thirty  lines   instead  of  thirty-two.     To 


68 


A    MANUAL   OF 


avoid  the  inconvenience  of  altering  the  magnification  in 
each  case — which  alteration  would  necessitate  altering  the 
length  of  the  tube  or  changing  the  objective,  or  both— 


Fig.  15,  l. 


B 


a  a 


Fig.  15,  2. 
B  C 


a 


B,  C,  lines  upon  stage  micrometer;  A,  fixed  line  in  ocular;  a,  b,  movable  lines 
in  ocular. 

microscopists  make  use  of  a  form  of  micrometer  essentially 
the  same  as  that  used  b)r  astronomers  in  measuring  the 
apparent  diameter  of  the  heavenly  bodies.  This  con- 
sists of  an  ocular  (Fig.  15,  l)  through  which  may  be  seen 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         69 

projected  upon  the  stage  micrometer  a  fixed  line  A,  and 
two  movable  lines  a,  b.  The  latter  <  a 1 1  be  moved  across 
the  field  of  the  microscope  by  means  of  a  wheel  (not  rep- 
resented in  the  figure),  the  distance  traversed  by  cither  of 
the  threads  from  the  fixed  line  being  determined  by  the 
number  of  divisions  through  which  the  wheel  is  rotated 
(Fig.  15,  3).  As  an  illustration  of  the  manner  in  which 
this  is  accomplished,  let  us  suppose  that  the  thread  b  is 
made  to  coincide  with  the  fixed  line  A  of  the  ocular,  and 
the  latter  is  made  to  coincide  at  the  same  time  with  the 
line  B  of  the  stage  micrometer  (Fig.  15,  2),  and  that  the 
wheel  is  turned  through  one  hundred  divisions ;  that  is, 
makes  one  complete  rotation.  It  will  be  observed  that  the 
line  b  will  traverse  the  space  between  the  lines  B  and  C 
of  the  stage  micrometer,  stopping  at  and  coinciding  with 
the  line  O.  By  the  turning  of  the  wheel  through  one 
hundred  divisions  the  line  b  has,  therefore,  been  made  to 
traverse  the  space  of  the  -nnjth  of  an  inch,  the  space  be- 
tween B  and  C  of  the  stage  micrometer  having  been  so 
graduated ;  consequently,  if  the  wheel  be  turned  through 
ten  divisions,  the  line  6  will  be  made  to  traverse  the 
yoW^1  °f  au  mcn;  and  so  on  proportionally.  The  rela- 
tion between  the  space  traversed  by  the  line  6  of  the  ocu- 
lar and  the  number  of  divisions  through  which  the  wheel 
is  turned  having  been  experimentally  determined  by 
means  of  the  stage  micrometer,  the  latter  is  removed,  and 
the  object-glass  holding  the  object  to  be  measured  is 
substituted  in  the  field  of  the  microscope.  To  determine 
the  size  of  the  latter,  it  is  only  necessary  then  to  turn  the 
wheel  until  the  body  to  be  measured  (Fig.  15,  3)  is  exactlv 
circumscribed  by  the  fixed  line  A  and  the  movable  line  6 
of  the  ocular,  and  to  read  oif  the  number  of  divisions 
through  which  the  wheel  has  been  turned  to  accomplish 


70  A    MANUAL    OF 

this ;   for  example,  y^-th  of  an  inch  :  100  divisions  of 
wheel  : :  x  :  20  divisions  : 

x  =  5-g-Q"th  °f  an  mcn  =  diameter  of  body. 

It  is  evident,  however,  that  if  the  wheel  must  be  rotated 
through  twenty  divisions  and  a  fraction  of  a  division  in 
order  to  bring  the  body  to  be  measured  between  the  lines 
A  and  b,  that  fraction  might  be  such  that  even  with  a 
vernier  attached  to  the  wheel  it  would  be  impossible  to 
get  an  exact  reading,  and  consequently  the  measurement 
would  only  be  approximate. 

It  is  a  matter,  however,  of  the  greatest  difficulty  with 
high  powers  to  adjust  accurately  the  divisions  of  the 
eye-piece  micrometer,  whatever  form  of  instrument  may 
be  used,  to  either  those  of  the  stage  micrometer  or  to 
the  margins  of  the  objects  to  be  measured,  even  with 
all  the  ingenious  accessory  contrivances  that  have  been 
devised  to  facilitate  the  operation.  Indeed,  it  must  be 
admitted  that  the  measurement  of  so  small  a  body  as  the 
red  corpuscle,  even  when  made  by  a  most  skilful  micro- 
scopist  and  with  the  best  of  modern  instruments,  from  the 
very  nature  of  the  case  can  never  be  anything  but  an  ap- 
proximate one.  If  the  measurement  of  the  red  blood- 
corpuscle  from  freshly-drawn  blood  and  under  the  most 
favorable  circumstances  is  at  best  only  approximative, 
how  much  more  so  must  such  measurement  be  in  the  case 
of  a  blood-stain  where  the  size  of  the  blood-corpuscle  will 
depend  upon  the  relative  amount  of  the  fluid  absorbed 
that  was  used  in  its  preparation  for  microscopical  examina- 
tion ?  Indeed,  one  of  the  greatest  difficulties  experienced 
in  restoring  the  form  of  the  blood-corpuscles  obtained  from 
a  blood-stain  is  to  prevent  them  becoming  distorted, 
swollen,  or  even  bursting  from  excessive  absorption  of  the 
fluid  used  in  their  preparation.     The  size  of  a  corpuscle, 


MEDICAL  JUKI8PKUDENCE    AM)   TOXICOLOGY.        71 

as  obtained  from  a  blood-stain,  can  only  bo  regarded  then 
as  representing  approximately  the  size  of  the  corpuscles  of 
such  blood.  Further,  it  must  be  borne  in  mind,  in  this 
connection,  that  while  about  ninety  out  of  every  hundred 
red  corpuscles,  whether  the  blood  be  that  of  man  or  other 
mammals,  have  the  same  diameter,  the  latter  depending 
upon  the  species;  of  the  remaining  ten  corpuscles,  some 
are  larger,  some  smaller  than  the  average  corpuscle.  That 
being  the  case,  if  it  just  so  happened  that  only  the  ex- 
ceptionally small  corpuscles  were  present,  the  blood,  though 
human,  might  be  erroneously  regarded,  on  account  of  the 
small  size  of  the  corpuscles,  as  that  of  a  dog,  for  example, 
in  which  the  corpuscles  are  smaller  than  those  of  man. 
On  the  other  hand,  if  the  blood  examined  was  that  of  a 
dog,  but  only  the  exceptionally  large  corpuscles  were 
obtained,  such  blood,  on  account  of  the  large  size  of  its 
corpuscles,  might  improperly  be  considered  as  human. 

It  must  be  admitted,  therefore,  that  while  the  red  blood- 
corpuscles  of  the  mammalia  can  be  shown  by  measurement 
to  differ  in  size  (see  table),  the  blood  examined  being 
freshly  drawn  in  each  instance,  red  blood-corpuscles  as 
obtained  from  blood-stains  cannot  be  positively  identified 
by  such  a  method  as  human  red  blood-corpuscles.  Any 
evidence  offered  as  positive  proof  based  upon  micrometric 
methods  that  blood  is  human,  as  distinguished  from  other 
mammalian  blood,  must  be  regarded  as  only  circumstantial 
at  best,  for  the  following  three  reasons  mentioned  above : 
1.  The  micrometric  method  is  approximative.  2.  The 
size  of  the  corpuscle  restored  is  variable,  depending  upon 
the  amount  of  fluid  absorbed.  3.  The  size  of  the  cor- 
puscles varies,  even  in  the  blood  of  the  same  mammal. 


72 


A    MANUAL,   OF 


Table   of   Blood-Corpuscles  (Diameters  in  fractions 
of  an  inch). 

Birds. 


Mammals. 

Diameter. 

Manatee 2T0  o 

Elephant 27V5 

Ant-eater ^759 

Sloth 

Whale 

Camel 

Man 

Orang      s^sa 

Chimpanzee 3T12 


2865 

1 

3099 
1 

312  3 

1 

3  200 


Opossum     .... 

Rabbit 

Black  Rat  ...    . 

Mouse 

Brown  Rat      .    .    . 
Gray  Squirrel    .    . 

Ox 

Cat 

Sheep      

Goat 

Pigmy  Musk  Deer 


3TT2 
_  1 
3557 
i_ 

3  607 

"375? 

1 

3  8  l¥ 

J 

3911 

_1 

¥000 

1 
¥2  6  7 

¥¥o¥ 
_  1  _ 
5300 
1 

63  66 

1 

12325 


Ostrich 
Owl    . 
Swan 
Pigeon 


Diameter. 
1 

■      •  T6¥9 
_  1 

•  •    1763 

1 

•  ■    1806 

1  _ 

•  '    1TJ73 


Reptiles. 

Turtle xaVi 

Viper    

Lizard 


127? 

1 

1555 


Amphibia,. 

Amphiuma 3^3 

Proteus £00 

Siren ?|o 

Menopoma -$\z 

Fishes. 

Pike 2^0  0 

Perch 21W 

Lamprey 2Ts¥ 


The  red  blood-corpuscles  of  man  and  the  mammalia 
generally  can  be  readily  distinguished,  however,  from 
those  of  birds,  reptiles,  and  fishes,  the  latter  being  not 
only  relatively  of  large  size,  but  oval  in  form  and  nu- 
cleated (Fig.  16).  It  should  be  mentioned,  in  this  con- 
nection, that  the  red  corpuscles  of  the  camel  and  llama  are 
oval,  and  that  those  of  the  lamprey  are  somewhat  circular. 
No  difficulty  should  arise  on  account  of  this  circumstance, 
for,  as  in  the  case  of  the  camelidse,  the  corpuscles  are 
without  a  nucleus,  though  ovoid  in  form ;  while  in  the 
lamprey  the  corpuscles  are  nucleated,  even  if  circular. 
The  fact  that  the  red  corpuscle  of  a  bird  differs  in  form 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.        73 

and  in  size  from  that  of  a  mammal  is  important  from  a 
medico-legal  point  of  view.  As  an  illustration,  let  us 
suppose  that  in  the  ease  of  blood-stains  found  in  a  wagon 

Fig.  16. 


M  AM   M  A   L  S, 


nrrnn 


£  MUSK   DEER  CAMEL 


•3200        I      1-30.99       1      1-2/45       I      I-42G8       I      1-4600       I       1-12325      I        1-3123 


BIRDS. 


Blood-corpuscles  of  vertebrates. 


in  which  a  person  was  suspected  to  have  been  murdered, 
the  explanation  offered  by  the  person  accused  of  the  crime 
was  that  the  blood  spilled  was  that  of  a  chicken  which 
had  been  killed  by  him  for  market.     If,  after  examination, 


74  A    MANUAL   OF 

the  expert  testified  that  the  red  blood-corpuscles  obtained 
from  the  blood  were  round  and  without  nucleus,  that 
testimony  alone  would  prove  that  the  statement  of  the 
defendant  was  false,  and  would  be  presumptive  evidence 
of  guilt,  and  might  lead  to  the  confession  of  the  crime  and 
to  conviction. 

Fig.  17. 


Prismatic  crystals  from  human  blood. 

Blood-crystals  (Fig.  17),  due  to  the  crystallization  of 
the  haemoglobin  or  coloring  matter  of  the  blood,  consti- 
tute an  important  proof  of  the  existence  of  blood.1  The 
blood-crystals  can  be  readily  obtained  from  freshly-drawn 
human  blood  by  evaporating  a  drop  of  the  blood  to  dry- 
ness on  a  glass  slide,  adding  a  drop  of  distilled  water,  and 
allowing  the  water  to  evaporate  under  a  thin  glass  cover. 
The  glass  slide  having  been  transferred  to  the  stage  of  the 
microscope,  the  crystals  will  soon  appear  in  certain  forms 

xPreyer:  Die  Blut-Ory  stalk.  Jena,  1871;  Dragendorf  in  Maschka, 
vol.  i.  S.  483. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         75 

and  sizes,  but  usually  as  small  prisms.1  If  the  blood  sub- 
mitted for  examination  has,  however,  undergone  changes 

such  as  would  have  occurred  in  the  case  of  a  blood-clot, 
the  following  will  be  found  a  convenient  methoa  of  ob- 
taining the  crystals  :  Triturate  the  substances  suspected  to 
be  blood  in  a  mortar  with  a  little  common  salt,  add  glacial 
acetic  acid,  and  warm  the  mixture  till  bubbles  appear ; 
then  set  aside  to  cool.  If  the  substance  so  treated  con- 
tains hsematin,  that  is,  modified  haemoglobin,  crystals  of 
hsematin  hydrochlorate  will  appear  as  rhombic  tablets, 
stars,  or  crosses.  The  presence  of  such  blood-crystals  may 
be  regarded  as  proving  that  the  material  from  which  they 
were  obtained  was  blood,  but  not  necessarily  human  blood, 
since  the  crystals  of  the  blood  of  certain  animals  are  un- 
distinguishable  from  those  of  man.  Therefore,  the  presence 
of  blood-crystals  as  evidence  that  a  suspected  material  from 
which  they  have  been  obtained  is  blood  is  even  of  less 
value  from  a  medico-legal  point  of  view  than  the  presence 
of  blood-corpuscles,  since  the  microscopist  is  unable,  from 
the  form  of  the  latter  at  least,  to  distinguish  the  blood  of 
the  mammalia  from  that  of  other  vertebrata. 

The  spectroscopic  method  of  investigating  blood-stains 
is  based  upon  the  fact  that  blood  interferes  with  the  trans- 
mission of  certain  rays  of  light,  and  that  it  gives  rise  to 
what  are  known  as  the  dark  absorption  bands  of  the  blood 
spectrum.  It  is  well  known  that  wheu  sunlight  is  trans- 
mitted through  a  prism  it  is  decomposed  into  the  seven 
colors :  Violet,  indigo,  blue,  green,  yellow,  orange,  red. 
If,  however,  a  weak  solution  of  arterial  blood  be  placed 

1  Another  method  is  to  mix  together  in  a  watch-glass  a  drop  of  blood 
with  glacial  acetic  acid  in  excess,  and  evaporate  to  dryness  slowlv  over 
a  spirit  lamp.  The  mass  so  obtained,  when  viewed  under  the  micro- 
scope, will  usually  exhibit  the  crystals  in  great  numbers. 


76 


A  MANUAL,  OP 
Fig.  18. 


Red,  Orange. Yellow.  Green. 


^4  olB  o     J> 


Blue. 


Indigo.  Violet. 


Oxyhemoglobin, 
and  N02-Haj- 
moglobin: 


CO-Haemoglobiiu 


Beduced  Haemo- 
globin. 


Haematin  in  acid 
solution. 


Haematin   in   al- 
kaline solution. 


Beduced  Hsema- 
tin. 


Solar  spectrum 
with  Fraun- 
hofer's    lines. 


I I""'""l "T 


/  3  9  10        11        12         IS        14 

Spectra  of  blood. 


Fig.  19. 


Layer  of  blood  in  a  glass  vessel  through  which  the  light  is  transmitted. 

Scheme  of  a  spectroscope  for  observing  the  spectrum  of  blood.  A,  Tube.  S,  Slit. 
m  m,  Layer  of  blood  with  flame  in  front  of  it.  P,  Prism.  M,  Scale.  B,  Eye  of 
observer  looking  through  a  telescope,    r  v,  Spectrum. 


MEDICAL  JURISPRUDENCE    AND   TOXICOLOGY.        77 

between  the  souree  of  light  and  the  prism,  two  dark 
bands  will  appear  (Fig.  18)  in  that  part  of  the  spec- 
trum previously  occupied  by  the  yellow  ray,  and  more 
particularly  in  that  portion  of  the  yellow  ray  adjoining  the 
orange  and  green  rays,  the  two  dark  bands  being  sepa- 
rated by  that  part  of  the  yellow  ray  still  transmitted 
through  the  blood.  If  the  arterial  blood  be  now  replaced 
by  venous  blood,  or  simply  deoxidized,  as  can  be  done  by 
appropriate  means,  the  two  dark  bands  will  disappear,  and 
in  that  part  of  the  spectrum  where  the  yellow  ray  was 
transmitted  there  will  appear  one  dark  band,  while  that 
part  of  the  spectrum  lying  on  either  side  of  the  dark  band 
will  be  occupied  to  a  small  extent  by  the  yellow  ray.  By 
means  of  the  spectroscope  not  only  can  a  suspected  mate- 
rial be  proved  to  be  blood  and  arterial  distinguished  from 
venous  blood,  but  blood  in  general  can  be  distinguished 
from  that  which  has  absorbed  carbonic  oxide  gas,  as  also 
from  solutions  of  acid  alkali  and  reduced  hsematin,  the 
dark  bands  presented  by  their  spectrum  being  different  in 
each  instance  (Fig.  18).  The  spectroscopic  method  is  the 
most  convenient,   reliable,   and   delicate  of  the  different 

methods  which  have  been  described  for  investigating-  blood- 
ed o 

stains. 

The  spectroscope  employed  in  medico-legal  examinations 
is  the  same  as  that  used  in  chemical  and  physical  re- 
searches, the  essential  parts  being  shown  in  Figure  19, 
or  it  may  consist  simply  of  a  spectroscopic  attachment  to 
a  microscope.  The  delicacy  of  the  spectroscopic  method 
of  investigating  blood-stains  is  such  that  a  solution  con- 
sisting of  one  grain  of  haemoglobin,  upon  which  the  absorp- 
tion of  the  light  depends,  to  a  pint  of  water  will  interfere 
with  the  transmission  of  strong  sunlight  sufficiently  to 
render  the  two  dark  bands  visible.     It  thus  becomes  pos- 


78  A    MANUAL    OF 

sible,  by  means  of  a  spectroscope,  to  state  positively  that 
stains  years  old  on  wood,  linen,  or  iron,  even  when  found 
in  a  putrid  condition,  were  made  by  blood.  It  is  true 
that  the  spectra  of  solutions  of  the  coloring  matter  of  the 
petals  of  cineraria,1  of  cochineal,  madder,  and  other  red 
dyes,  present  dark  bands  in  their  spectrum,  but  their  situ- 

Fig.  20.  Fig.  21. 


Blood  before  coagulation.  Blood-clot  floating  in  the  fluid  serum 

after  coagulation. 

ation  is  either  not  exactly  the  same  as  those  of  the  blood 
spectrum,  or  they  can  be  distinguished  from  those  of  the 
latter  by  the  action  of  ammonia  and  potassium  sulphate. 

The  spectroscopic  method  of  investigating  blood-stains, 
reliable  and  delicate  though  it  may  be,  does  not  enable  the 
examiner  to  state  that  a  suspected  material  is  human  blood, 
but  only  blood.  By  none  of  the  methods,  therefore,  of 
examining  blood-stains,  whether  chemical,  microscopic,  or 
spectroscopic,  can  human  blood  be  distinguished  positively 
from  that  of  other  animals. 

Coagulation  of  Blood. — One  of  the  most  remarkable 
properties  of  the  blood  is  its  power  of  separating  into  clot 
and  serum,  due  to  the  coagulation  and  subsequent  shrink- 
age of  its  fibrin  (Figs.  20,  21),  the  process  being  com- 

1  Of  the  different  menstrua  used  by  the  writer  to  obtain  the  color- 
ing matter  from  the  petals  of  cineraria,  glacial  acetic  acid  was  found  to 
be  the  best. 


MEDICAL  JURISPRUDENCE   AND  TOXICOLOGY.        70 

pleted  outside  the  body  within  a  period  of  from  10  to  \'Z 
hours. 

BLOOD. 

Before  Coagulation.  After  Coagulation. 

f  Water,  f 

T.  „  .    .  Albumen,     >  i  Serum. 

Liquor  Sanguinis,     -i   SaUg)        ^  [ 

[  Fibrinogen^.         . 

">  I  Clot. 
Corpuscles, ^ 

Conditions  Influencing  Coagulation  of  Blood. — While 
the  blood  does  not  usually  coagulate  in  the  living  body,  it 
almost  invariably  does  so  in  the  dead  body,  and  within 
a  period  varying  between  12  and  24  hours.  There  are 
various  conditions  which  influence  the  coagulation  of  the 
blood  within  and  without  the  body,  some  of  which  are 
better  understood  than  others.  Only  those  conditions  in- 
fluencing coagulation  which  may  have  an  importance  from 
a  medico-legal  point  of  view  need  be  here  considered. 
Blood  flowing  from  a  small  orifice  coagulates  more  quickly 
than  when  flowing  from  a  large  one ;  more  quickly  when 
it  is  received  into  a  shallow  rough  vessel  than  when  in  a 
deep  smooth  one.  The  coagulation  of  the  blood  is  retarded 
or  even  prevented  when  mixed  with  solutions  of  sodium 
sulphate  and  carbonate.  Rapid  freezing  will  prevent  the 
coagulation  of  the  blood ;  blood  so  frozen  will,  however, 
coagulate  if  carefully  thawed.  A  temperature  of  from  32° 
to  140°  F.  favors  coagulation.  The  menstrual  blood  is  kept 
in  a  more  or  less  fluid  condition  by  the  vaginal  secretions. 

The  medical  expert  is  often  asked  to  express  an  opinion 
as  to  how  much  blood  the  body  of  the  deceased  contained. 
While  it  is  impossible  to  state  exactly  how  much  blood 
there  is  iu  any  human  body,  it  may  be  said  that  on  an 
average  there  is  one  pound  of  blood  for  every  eight 
pounds  of  body- weight ;  that  is,  there  would  be  about  six- 


80  A    MANUAL  OP 

teen  pounds  of  blood  in  the  body  of  a  man  weighing  one 
hundred  and  twenty-eight  pounds.  This  estimate  is  based 
upon  the  fact  that  twelve  pounds  of  blood  were  collected 
during  the  execution  by  beheading  of  a  criminal  weighing 
one  hundred  and  twenty-eight  pounds,  and  that  four 
pounds  of  blood  were  obtained  after  the  execution  by 
washing  out  the  blood-vessels. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.        <S  1 


CHAPTER  VI. 

Burns  and  Scalds — Death  from  Suffocation  by  Strangulation — Hanging 
— Drowning. 

A  burn  may  be  defined,  medico-legally,  as  an  injury 
produced  by  the  application  of  a  heated  substance  to  the 
surface  of  the  body,  while  a  scald  results  from  the  appli- 
cation of  a  liquid  at  about  its  boiling-point.  The  effects 
of  burns  and  scalds  upon  the  body  are  essentially  the  same. 
Burns  vary  in  their  intensity  from  a  mere  redness  of  the 
skin  to  a  complete  carbonization  of  the  body. 

The  danger  from  burns  depends  more  on  their  extent 
than  upon  their  depth.  This  is  due  to  the  .fact  that  the 
excretory  and  heat-regulating  functions  of  the  skin  are 
interfered  with  in  proportion  to  the  extent  of  the  skin 
involved. 

It  may  be  stated,  as  a  general  rule,  that  if  one-third  of 
the  body,  or  even  one-third  of  the  skin,  be  severely  burned, 
the  burn  will  probably  prove  fatal.  Death  in  the  case  of 
burns  is  usually  due  to  shock,  though  often  caused  by  suf- 
focation, exhaustion,  or  gangrene.  It  must  be  remem- 
bered, however,  that  the  result  of  burns  will  be  very  much 
influenced  by  the  age  and  constitution  of  the  individual 
and  the  part  of  the  body  affected.  Thus,  for  example, 
burns  are  more  dangerous  in  the  young  than  in  the  old ; 
more  so  on  the  trunk  of  the  body  than  on  the  limbs ;  more 
so  if  in  separate  patches  than  when  continuous,  supposing 
the  parts  burned  are  of  equal  extent. 

The  post-mortem  appearances  observed  in  cases  of  death 


82  A    MANUAL   OF 

from  burns  are  not  very  constant.  Among  those  frequently 
noticed,  however,  are  capillary  injection  of  the  mucous 
membrane  of  the  alimentary  canal  and  bronchi,  perfora- 
ting ulcers  of  stomach  and  duodenum,  and  serous  effu- 
sion of  the  ventricles  of  the  brain.  It  has  frequently 
occurred  that  the  body  of  a  person  murdered  has  been 
burned  after  death,  in  the  hope  that  the  death  might  be 
attributed  to  accident,  and  so  enable  the  murderer  to 
escape  the  consequences  of  his  crime.  It  may  become, 
therefore,  very  important  in  medico-legal  cases  for  the  ex- 
aminer to  be  able  to  state  whether  a  body  was  burned 
during  life  or  after  death.  Among  the  facts  that  may  be 
mentioned  as  proving  that  burns  had  been  inflicted  during 
life  an  important  one  is  the  presence  of  blisters  and  par- 
ticularly of  blisters  containing  serum.  It  is  true  that 
blisters  may  be  produced  a  few  minutes  after  death  by 
heat ;  but  when  so  produced  they  contain  air,  not  serum.1 
It  should  be  mentioned,  however,  that  in  the  case  of  drop- 
sical persons  blisters  containing  serum  might  be  produced 
by  the  application  of  heat  after  death.  On  the  other  hand, 
the  absence  of  blisters  does  not  prove  that  a  body  was  not 
burned  during  life,  since  blisters  do  not  necessarily  result 
from  burns.  Further,  blisters,  even  when  present,  are 
sometimes  so  modified  by  the  effects  of  the  heat  when 
intense  as  to  be  unrecognizable.  Another  proof  that  a 
body  has  been  burned  during  life  is  the  presence  of  a  red 
line  around  the  burn,  the  color  of  which  gradually  fades 
away  into  that  of  the  surrounding  skin.  This  red  line 
remains  after  death,  and  cannot  be  produced  by  the  appli- 
cation of  heat  to  the  dead  body.  It  must  be  admitted, 
however,  that  it  is  often  extremely  difficult  to  state  posi- 
tively whether  a  body  has  been  burned  during  life  or  after 
1  Christison  :  Edinburgh  Medical  Journal,  1831,  p.  3^0. 


MEDICAL   JU'UINIMIUDKNCK    AND    TOXICOLOGY.         8)5 

death.  Indeed,  if  a dead  body  he  found  completely  chaired, 
it  would  be  impossible  to  decide  whether  the  individual 
had  been  burned  alive  or  not. 

Death  from  Suffocation. — Death  from  suffocation,  whether 
by  strangulation,  hanging,  or  drowning,  or  however  pro- 
duced, is  due  in  each  instance  to  the  same  cause — the 
deprivation  of  the  system  of  air,  or  asphyxia.  Apart  from 
the  three  principal  modes  of  death  from  suffocation,  which 
have  just  been  referred  to,  and  which  will  be  considered 
separately,  there  are  other  modes  of  death  from  suffocation 
less  common  than  those  mentioned,  but  occurring  so  fre- 
quently as  to  demand  some  attention.  Thus,  for  example, 
infants  are  frequently  suffocated  accidentally  from  being 
too  closely  wrapped  up,  or  from  being  rolled  upon  by  their 
mothers,  often  so  intoxicated  as  to  be  unaware  of  what  they 
are  doing.  Children,  feeble  persons,  and  drunkards  have 
been  suffocated  by  falling  into  ash-heaps,  dirt-piles,  etc. 
The  passage  into  the  larynx  of  marbles  and  whistles  acci- 
dentally swallowed  by  children,  of  half-chewed  meat  bolted 
through  over-haste  in  eating — a  habit  unfortunately  too 
common  even  in  adults — is  a  not  uncommon  cause  of  suf- 
focation.1 Occasionally,  suffocation  is  intentionally  pro- 
duced, as  in  cases  where  individuals,  having  determined  to 
commit  suicide,  force  foreign  bodies,  like  balls  of  hay,  for 
example,  down  their  own  throats.  Death  from  suffocation 
may  be,  however,  homicidal  as  well  as  accidental  or 
suicidal.  Indeed,  one  of  the  commonest  ways  of  killing 
new-born  children  is  by  suffocation,  the  crime  being  easily 
committed  and  leaving  but  few  traces  to  tell  the  tale. 
Frequently,  persons  have  been  suffocated  by  having  foreign 
bodies  like  corks  and  pieces  of  meat  forced  down  their 

1  Tidy  :  op.  cit.,  part  ii.  pp.  448,  449 ;  Taylor :  op.  cit.,  p.  426 ;  "Whar- 
ton and  Stille  :  vol.  iii.  p.  348. 


84  A   MANUAL   OP 

throats,  the  murderers  hoping  that  death  would  be  at- 
tributed to  accidental  suffocation,  and  thus  have  suspi- 
cion diverted  from  themselves.  Therefore,  the  medical 
examiner,  in  cases  of  death  from  suffocation,  even  after 
most  careful  examination,  should  be  extremely  cautious  in 
expressing  an  opinion  as  to  whether  death  was  accidental, 
suicidal,  or  homicidal.  The  post-mortem  appearances 
usually  observed  in  cases  of  death  from  suffocation  and 
from  causes  such  as  those  mentioned  are  lividity  of  the  face 
and  lips,  congestion  of  the  eyes,  bloody  mucous  froth  about 
the  mouth  and  nose,  congestion  of  the  lungs  and  of  the 
right  side  of  the  heart  and  kidneys. 

Death  from  Suffocation  by  Strangulation. — Strangulation 
may  be  produced  either  by  simple  pressure  of  the  hand 
on  the  windpipe,  as  in  throttliug,  or  by  means  of  a  rope, 
strap,  handkerchief,  piece  of  a  sheet,  bowstring,  etc.  It 
differs  from  hanging  principally  in  the  position  of  the  cord, 
which  is  horizontal  in  the  former  case  and  oblique  in  the 
latter.  From  a  medico-legal  point  of  view  this  is  an  im- 
portant distinction,  since  death  from  strangulation  would 
be  usually  regarded  as  homicidal,  that  from  hanging  as 
suicidal.  Among  the  signs  of  death  from  strangulation 
may  be  mentioned  the  staring  eyes  with  dilated  pupils,  the 
livid  and  swollen  face,  the  protruding  and  often-bitten 
tongue,  blood  about  the  nose,  mouth,  and  ears,  turgidity  of 
the  genitalia,  with  escape  of  urine  and  feces.  The  larynx 
is  flattened,  congested  internally,  and  coated  over  with  a 
bloody  frothy  mucus.  The  right  side  of  the  heart  and  the 
venous  system  are  gorged  with  blood.  The  marks  made 
by  the  fingers  and  thumb  upon  the  front  of  the  neck,  as  in 
throttling,  or  the  horizontal  mark  or  marks  made  by  the 
cord  according  to  the  number  of  times  it  was  wound  around 
the  neck,  with  the  infiltrated  blood  beneath,  are  striking 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         85 

evidences  of  death  from  strangulation.  It  is  true  that  such 
marks  can  be  made  by  winding  a  cord  around  the  neck  of 
a  dead  body,  and  that  therefore  too  much  importance  must 
not  be  attached  to  their  presence ;  but  it  must  be  borne 
in  mind  that  the  livid,  swollen  countenance,  the  protruded 
tongue,  the  staring  eyeballs,  which  are  always  present  in 
death  from  strangulation,  and  which  cannot  be  produced 
after  death,  must  be  always  taken  into  consideration,  as 
well  as  the  marks  observed  on  the  front  of  the  neck. 
According  to  Tidy,1  an  ecchymosed  mark  can  be  pro- 
duced experimentally  within  three  hours,  a  non-ecchy- 
mosed  one  within  six  hours,  after  death.  Casper,  how- 
ever, states,2  as  the  results  of  his  experiments,  "  that  any 
ligature  with  which  any  body  may  be  suspended  or 
strangled,  not  only  within  a  few  hours,  but  even  days 
after  death,  especially  if  the  body  be  forcibly  pulled 
downward,  may  produce  a  mark  precisely  similar  to  that 
which  is  observed  in  most  of  those  hanged  while  alive." 
It  is  remarkable  that  the  marks  of  strangulation  some- 
times persist  weeks  and  even  years  after  burial. 

Strangulation  is  sometimes  produced  accidentally.  Cases 
have  occurred,  for  example,  where  death  was  due  to  com- 
pression of  the  windpipe  by  straps  or  strings  habitually 
worn  around  the  necks  of  persons  engaged  in  carrying 
heavy  baskets  of  fish  or  vegetables  for  sale.  Suicidal  stran- 
gulation is  rare.  Among  the  insane,  however,  it  is  not  of 
unfrequent  occurrence,  being  so  easily  accomplished.  In- 
deed, in  certain  cases  it  requires  the  greatest  vigilance  on 
the  part  of  the  attendants  to  prevent  it. 

Death  from  Suffocation  by  Hanging. — In  this  mode  of 
death  the  body  is  suspended  by  the  neck,  the  weight  of  the 

1  Tidy  :  op.  cit.,  part  ii.  p.  431. 

2  Casper:  op.  cit,  vol.  ii.  p.  173. 


8b  A    MANUAL   OF 

body  acting  as  the  compressing  force.  If  the  neck  is  com- 
pressed beneath  the  thyroid  cartilage,  death  is  usually  due 
to  asphyxia,  and  is  rapid ;  but  if  just  beneath  the  chin,  as 
is  usually  the  case  in  executions,  to  congestion  of  the  brain 
(apoplexy),  and  is  slow.  In  most  cases,  however,  death  is 
due  rather  to  the  effects  of  both  causes  combined.  Occa- 
sionally, death  is  caused  immediately  by  pressure  upon  the 
spinal  cord  through  fracture  or  displacement  of  the  odon- 
toid process  of  the  second  cervical  vertebra.  The  hyoid 
bone  and  thyroid  cartilage  have  also  in  some  instances  been 
fractured.  Death  from  fracture  of  the  vertebra?  in  hang- 
ing, however,  is  not  so  frequent  as  is  usually  supposed.  The 
post-mortem  appearances  observed  in  cases  of  death  from 
hanging  do  not  differ  essentially  from  those  already  de- 
scribed in  death  from  strangulation.  Indeed,  the  mere 
inspection  of  the  body  will  not  enable  the  examiner  to  state 
positively  that  death  was  due  to  hanging.  The  flow  of 
saliva  out  of  the  mouth,  down  the  chin,  and  straight  down 
the  chest,  is  possibly  one  of  the  most  positive  signs  of  this 
kind  of  death ;  but  the  absence  of  such  a  flow  would 
hardly  justify  the  examiner  in  stating  that  death  was  not 
due  to  hanging.  It  is  also  extremely  difficult  to  determine, 
when  a  body  is  found  dead  from  hanging,  whether  the 
death  should  be  regarded  as  accidental,  suicidal,  or  homi- 
cidal. It  is  true  that  in  cases  of  suicide  by  far  the  greatest 
number  are  committed  by  hanging ;  but  that  would  only 
lead  to  a  presumption  as  to  the  cause  of  death.  From  the 
fact  that  very  young  children  rarely  commit  suicide,  it 
might  be  supposed  that  the  age  of  the  deceased  might 
assist  the  examiner  to  some  extent  in  determining  the  cause 
of  death.  It  must  be  remembered,  however,  that  suicide 
has  been  committed  by  hanging  by  a  boy  of  nine  and  by 
a  man  of  ninety-seven  years  of  age,  and  that  death  from 


MIMICAL   JURISPRUDENCE    AND   TOX  U'<)\.<><:  V.         <S7 

the  same  cause,  though  accidentally  occasioned,  is  not  of 
mi  frequent  occurrence  among  children. 

Death  from  Suffocation  by  Drowning. —  In  death  from 
drowning,  suffocation  is  caused  by  the  presence  of  some 
liquid,  usually  water,  which,  interfering  with  the  passage 
of  air  into  the  respiratory  passages,  acts  even  more  effec- 
tually than  when  the  throat  is  compressed  externally,  as 
in  strangulation  or  hanging — the  water  entering  even  the 
bronchial  tubes  and  air-vesicles.  A  human  being,  as  a 
general  rule,  dies  if  submerged  for  a  period  of  from  four 
to  five  minutes.  In  order  that  a  person  should  be  suf- 
foeated  by  drowning,  it  is  not  necessary,  however,  that 
the  whole  body  should  be  submerged.  It  is  of  no  un- 
common occurrence  to  find  the  dead  bodies  of  persons, 
such  as  drunkards  and  epileptics,  lying  face  downward 
in  shallow  pools  into  which  they  had  fallen  and  by  which 
they  had  been  suffocated.  The  external  signs  presented 
by  a  drowned  person  will  vary  with  the  length  of  time  the 
body  has  been  in  the  water.  Supposing  the  body  not  to 
have  been  in  the  water  longer  than  two  or  three  hours, 
and  not  to  have  been  inspected  immediately  after  removal, 
the  face  will  be  found  pale,  the  eyes  half  open,  the  eye- 
lids livid,  the  pupils  dilated,  the  mouth  usually  open,  the 
tongue  swollen,  often  indented  by  the  teeth,  the  lips  and 
nostrils  covered  with  a  mucous  froth.  The  skin  usually 
presents  the  condition  known  as  goose-flesh,  and  the  penis 
is  retracted.  In  addition  abrasions  are  often  found  upon 
the  body,  especially  upon  the  hands,  which  frequently  con- 
tain particles  of  sand,  gravel,  mud,  and  pieces  of  wood 
grasped  by  the  drowning  person  in  his  struggle  for  life. 
Internally,  the  lungs  are  found  disteuded,  overlapping  the 
heart,  sodden  and  doughy,  owing  to  the  water  drawn  in, 
and  full  of  bloody  mucous  froth.     In  cases  in  which  the 


88  A   MANUAL   OF 

lungs  contain  little  or  no  water,  the  water  will  be  found  in 
the  pleural  cavities,  into  which  it  has  transuded.  Fre- 
quently, water  is  found  in  the  stomach,  together  with  parts 
of  weeds,  sand,  and  mud,  such  as  are  present  in  the  ponds 
or  river  in  which  the  person  was  drowned.  As  a  general 
rule,  the  right  side  of  the  heart  is  gorged  with  dark  blood. 
Both  sides  of  the  heart  may,  however,  be  distended  with 
blood. 

The  remaining  organs  do  not  present  any  characteristic 
changes.  As  the  human  body  is  somewhat  heavier  than 
water,  the  body  of  a  drowned  person  will  remain  sub- 
merged until,  through  the  development  of  putrefying  gases, 
it  becomes  sufficiently  light  to  float.  The  time  elapsing 
between  the  moment  when  a  person  is  drowned  and  that 
at  which  the  body  will  come  to  the  surface,  varies  with  the 
temperature  of  the  air  and  water,  the  buoyancy  of  the  lat- 
ter, the  age,  sex,  and  constitution  of  the  individual.  In 
summer  a  body  may  float  within  twenty-four  hours  after 
drowning.  A  drowned  body  will  rise  to  the  surface 
sooner  in  salt  than  in  fresh  water.  Fat  bodies  float  sooner 
than  thin  bodies,  and  the  bodies  of  women  float  sooner 
than  those  of  men.  Though  a  matter  of  importance,  it  is 
often  impossible  to  state  positively,  in  the  case  of  a  body 
floating  in  the  water  supposed  to  have  been  drowned,  the 
length  of  time  that  has  elapsed  since  life  became  extinct. 
In  this  connection  it  can  only  be  stated  that  the  mucous 
froth  and  water  usually  found  in  the  lungs  of  drowned 
persons  disappear  after  putrefaction  sets  in ;  or  when  the 
body  has  been  exposed  for  any  great  length  of  time  to  the 
air. 

Death  from  drowning  is  usually  accidental  or  suicidal — 
rarely  homicidal,  however,  except  in  the  case  of  infants, 
which  are  frequently  gotten  rid  of  in  this  way.     But  it 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY. 


89 


must  be  borne  in  mind  that  a  person  might  be  murdered 
and  then  thrown  into  a  river  or  pond  with  the  idea  that 
death  would  be  attributed  to  drowning.  Therefore,  the 
body  of*  a  drowned  person  should  be  always  most  care- 
fully examined  for  marks  of  violence.  On  the  other  hand, 
the  presence  of  wounds  upon  a  body  found  dead  floating  in 
the  water  would  not  prove  that  the  case  was  one  of  homi- 
cide, since  suicides  have  frequently  inflicted  wounds  upon 
themselves  before  drowning.  The  fact  that  the  limbs  are 
found  tied  together,  that  a  stone  or  a  heavy  weight  is  sus- 
pended from  the  neck  of  a  body  taken  out  of  the  water, 
would  not  necessarily  indicate  homicide,  as  suicide  has 
often  been  committed  in  that  manner. 

Fig.  22. 


Resuscitation  after  drowning:  first  movement. 

Fig.  23. 


Resuscitation  after  drowning:  second  movement 


Resuscitation. — While  the  best  method  of  resuscitation  of 
a  drowned  person  is  not  strictly  a  medico-legal  question,  as 
the  propriety  of  the  treatment  of  drowned  persons  has  been 


90  A    MANUAL   OP 

severely  criticised  at  coroner's  inquests,  a  few  words  in 
connection  with  this  subject  may  not  seem  inappropriate. 
In  attempting  to  resuscitate  a  drowned  person,  the  first 
thing  to  do  is  to  remove  all  clothing  from  the  neck  and 
chest.  The  body  should  then  be  wiped  dry,  and  covered 
with  dry  clothes.  The  mucous  froth  that  has  collected 
within  the  nostrils,  mouth,  and  throat  must  be  cleaned  out, 
the  tongue  pulled  forward,  and  kept  from  falling  back,  in 
this  way  covering  the  larynx.  The  body  should  then  be 
placed  at  full  length,  face  downwards,  with  the  forehead 
resting  on  one  arm,  so  as  to  allow  all  fluids  to  run  out  of 
the  mouth.  Ammonia,  snuff,  aromatic  vinegar,  may  be 
now  cautiously  applied  to  the  nostrils.  If  by  these  means 
respiration  has  not  been  restored,  the  body  must  be  placed 
upon  its  back,  and  the  head  slightly  raised.  The  arms 
should  be  gently  carried  outwards  and  upwards,  raised  above 
the  head,  and  kept  momentarily  in  that  position  (Fig.  22). 
By  these  movements,  which  should  take  about  two  seconds, 
inspiration  is  effected,  and  air  passes  into  the  chest.  The 
arms  should  then  be  lowered  and  brought  closely  to  the 
sides  of  the  chest,  the  lower  part  of  the  breast -bone  being  at 
the  same  time  compressed  (Fig.  23).  These  movements,  by 
which  expiration  is  effected  and  air  driven  out  of  the  chest, 
should  also  be  made  in  about  two  seconds.  These  alternate 
movements  of  the  arms  should  be  repeated  about  fourteen 
times  a  minute.  As  soon  as  spontaneous  breathing  com- 
mences, heat  may  be  applied  either  in  the  form  of  a  warm 
bath  or  friction.  When  the  power  of  swallowing  returns, 
a  little  warm  brandy  and  water  may  be  given,  and  then 
the  patient  should  be  put  to  bed  and  allowed  to  sleep. 
This  treatment  should  be  persisted  in  for  several  hours, 
except  in  those  cases  where  the  body  has  been  long  under 
water  and  is  taken  out  cold  and  rigid — where  there  is  com- 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.         91 

plete  insensibility,  no  .spontaneous  breathing,  entire  absence 
of  the  heart-beat,  the  eyelids  half  closed,  the  lower  jaw 
stiff,  and  mucous  froth  continually  escaping  from  the 
nostrils  and  mouth.  On  the  other  hand,  slight  flushing  of 
the  face,  convulsive  twitches  of  the  face,  returning  warmth 
of  the  skin,  gasping  and  sobbing,  breathing  movements  of 
the  body  and  limbs,  are  signs  indicating  speedy  recovery. 


92  A   MANUAL   OF 


CHAPTER  VII. 

Death  from  Starvation — Death  from  Heat  and  Cold— Death  by  Light- 
ning. 

Death  from  Starvation. — The  symptoms  of  and  post-mor- 
tem appearances  in  death  from  starvation,  whether  the  sys- 
tem be  deprived  suddenly  or  gradually  of  food,  are  essentially 
the  same.  Advantage  is  often  taken  of  this  fact  by  those  in 
charge  of  so-called  "  baby- farms/'  where,  to  save  expense,  in- 
fants are  slowly  starved  by  food  insufficient  in  quantity  and 
quality,  and  where  their  death  is  attributed  to  the  diseases 
common  to  infancy.  Usually,  in  such  cases,  the  true  cause 
of  death  is  overlooked,  suspicion  even  being  averted,  as 
the  length  of  time  is  so  great  that  months  often  elapse 
before  death  is  accomplished  by  the  starving  process.  For 
this  reason  death  from  chronic  starvation  is  so  much  more 
common  than  from  acute  starvation.  Indeed,  death  from 
acute  starvation  occurs  almost  always  accidentally,  as  in 
the  case  of  those  who  are  buried  in  a  mine,  or  of  those  wTho 
are  shipwrecked  or  lost  on  desert  wastes.  Starvation  is 
very  rarely  suicidal.  Lunatics  and  prisoners  sometimes 
attempt  to  take  their  own  lives  by  abstaining  wholly  from 
food ;  but,  as  a  general  rule,  such  attempts  are  unsuccessful. 

Among  the  symptoms  of  starvation  may  be  mentioned 
severe  pain  in  the  epigastrium,  which  usually  passes  away 
in  a  day  or  so,  being  replaced  by  an  indescribable  feeling 
of  weakness,  a  sort  of  sinking.  The  face  becomes  pale 
and  cadaverous,  and  there  is  a  wild  look  in  the  eye. 
General  emaciation  follows,  and  an  offensive  odor  is  noticed 
about  the  body,  which  is  covered  with  a  brownish  secretion. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.        93 

The  voice  becomes  weak,  and  muscular  effort  impossible 
The  intelligence  can,  with  difficulty,  be  aroused.  Im- 
mediately before  death  there  is  a  decided  fall  in  the  tem- 
perature. Death  takes  place  usually  in  from  ten  to  twelve 
days,  often  accompanied  with  mania  and  convulsions. 
In  death  from  starvation  the  most  important  changes 
noticed  on  post-mortem  examination  are  the  loss  in  body- 
weight,  the  almost  entire  absence  of  fat  and  blood,  and 
the  loss  in  bulk  of  the  most  important  viscera.  The  coats 
of  the  intestines  are  sothinned  as  to  be  almost  transparent, 
the  gall-bladder  is  distended  with  bile,  and  decomposition 
sets  in  very  readily.  As  already  mentioned,  death  from 
inanition  or  chronic  starvation  is  characterized  by  the 
symptoms  and  post-mortem  changes  just  described  as  re- 
sulting in  death  from  acute  starvation.1 

Death  from  Heat  and  Cold. — Death  from  heat  does  not, 
as  a  general  rule,  become  a  subject  of  medico-legal  investi- 
gation. As,  however,  in  cases  of  death  from  sun-stroke, 
from  exposure  to  the  heat  of  engine-rooms,  etc.,  doubts 
may  be  raised  at  the  coroner's  inquest,  especially  in  the 
absence  of  witnesses,  as  to  whether  death  was  really  due  to 
such  causes,  and  was  not  suicidal  or  homicidal,  it  is  im- 
portant that  the  medical  examiner  should  be  familiar  with 
the  symptoms  and  post-mortem  changes  presented  in  such 
cases.  The  symptoms  of  exposure  to  excessive  heat, 
whether  to  that  of  the  direct  rays  of  the  sun,  or  to  that  of 

1  It  is  often  stated  that  the  quantity  of  food  required  by  a  healthy 
man  doing  work  during  twenty-four  hours  is  as  follows: 

Meat,  16  oz. 

Bread,  19  " 

Butter  or  fat,  3J  " 

Water,  52  fl.  oz. 

If  health,  however,  is  to  be  maintained,  fresh  vegetables,  fruits,  tea, 
coffee,  and  sugar  should  be  added  from  time  to  time  to  the  above  diet. 


94  A    MANUAL    OF 

the  peculiar  atmosphere  of  engine-rooms  and  factories, 
saturated  with  moisture,  and  therefore  interfering  with  the 
heat- regulating  functions  of  the  skin,  vary  from  headache 
with  drowsiness  to  complete  insensibility,  coma,  and  par- 
alysis. In  most  such  cases  death  appears  to  be  due  to 
paralysis  of  the  heart.  Among  the  post-mortem  appear- 
ances which  are  not  constant  may  be  mentioned  congestion 
of  the  brain  and  its  membrane,  serum  in  the  ventricles, 
congestion  of  the  heart,  lungs,  and  viscera.  In  some  cases, 
however,  there  is  anaemia  of  the  brain. 

Death  from  cold  is  usually  accidental,  occurring,  for  ex- 
ample, in  drunkards  who  have  fallen  asleep  in  the  snow, 
or  in  persons  who  have  lost  their  way  in  woods  or  in  snow- 
drifts. Death  from  cold  is,  however,  not  unfrequently 
homicidal.  Thus,  newly-born  infants  are  often  intention- 
ally frozen  to  death  by  exposure  to  the  air  of  a  very  cold 
winter  night.  Death  takes  place  very  quickly  under  such 
circumstances,  infants  having  but  little  power  to  resist 
cold.  Young  children  have  been  frozen  by  being  im- 
mersed in  vessels  of  ice-water.  Lunatics  have  died  of 
exhaustion  after  too  long  exposure  to  the  cold  shower- 
bath,  administered  as  a  punishment  for  misbehavior.  In 
all  such  cases  the  temperature  of  the  air,  the  season  of  the 
year,  the  time  of  day,  the  place  of  exposure  must  be  all 
taken  into  consideration  by  the  examiner. 

The  post-mortem  changes  in  death  from  cold  are  not 
characteristic.  Among  the  most  noticeable  are  the  general 
pallor  and  stiffness  of  the  body,  the  irregular  and  dif- 
fused red  patches  on  different  parts  of  the  body,  even  in 
such  as  are  not  dependent,  the  unusual  accumulation  of 
blood  on  both  sides  of  the  heart,  and  the  congestion  of  the 
viscera.  In  all  cases  of  death  supposed  to  be  due  to  cold, 
it  is  important  to  determine  whether  the  body,  when  found, 


MEDICAL   JUBISPEUDEN'CE    AND   TOXICOLOGY.        95 

was   putrefying,   since,  as   putrefaction    is   prevented   by 

freezing,  it  would  be  a  strong  proof,  if  a  body  were  found 
putrefied  in  ice  or  snow,  that  death  was  not  due  to  freezing, 
but  that  the  freezing  had  occurred  after  death. 

Death  by  Lightning. — Death  by  lightning  is  of  medico- 
legal interest  from  the  fact  that  in  the  case  of  bodies  found 
dead  in  remote  places  and  hearing  marks  of  violence  death 
has  been  attributed  to  murder  rather  than  to  litrhtninu;. 
The  effects  of  death  from  lightning  vary  considerably  in 
their  intensity.  Frequently  the  hair  is  singed,  the  skin 
deeply  burned  or  punctured,  the  clothes  burned,  the  boots 
torn  open.  If  such  articles  as  watch-chains  or  coins  or 
knives  happen  to  constitute  part  of  the  circuit,  they  will  be 
usually  found  melted  or  half  melted.  In  some  cases  the 
body  may  be  uninjured,  and  yet  the  clothes  burned  or  en- 
tirely torn  off.  In  other  cases  the  clothes  may  entirely  es- 
cape, and  yet  the  body  may  be  much  burned.  In  death  from 
lightning  the  brain  and  its  membranes  are  usually  found 
congested,  the  brain  being  frequently  disorganized.  The 
stomach,  intestines,  liver  are  usually  congested.  The  heart 
does  not  present  auy  marked  alteration.  The  lungs  are, 
however,  usually  congested  and  full  of  mucus.  Rigor  mor- 
tis frequently  sets  in  immediately  after  death.  In  such 
cases  the  body  is  found  in  exactly  the  same  attitude  as 
when  it  was  struck.  The  coagulation  of  the  blood  is  re- 
tarded.    On  the  other  hand,  putrefaction  is  accelerated.1 

1  For  post-mortem  appearances  presented  in  cases  of  death  by  elec- 
trocution or  from  the  accidental  application  of  electricity,  see  Taylor, 
op.  cit.,  p.  470 ;  Richardson :  Medical  Times  and  Gazette,  May  15,  1869, 
p.  511 ;  Allan  McLane  Hamilton  :  System  of  Legal  Medicine,  New  York, 
1894,  vol.  i.  p.  134;  vol.  ii.  p.  367.  Bullard:  "The  Medico-Legal  Re- 
lations of  Electricity,"  Medical  Jurisprudence,  Forensic  Medicine,  and 
Toxicology,  by  R.  A.  Witthaus  and  Tracy  C.  Becker,  vol.  ii.,  New  York, 
1S94. 


96  A    MANUAL    OF 

Death  by  lightning  is  usually  instantaneous,  being  due 
to  shock.  But  in  some  cases  death  is  delayed,  being  then 
due  to  some  affection  of  the  brain  or  spinal  cord,  such  as 
epilepsy,  paralysis,  effusion  of  blood,  tetanus,  etc.  The 
effect  of  a  stroke  of  lightning,  as  well  known,  is  very 
capricious.  Of  three  or  four  persons  sitting  under  a  tree 
one  or  two  only  may  be  killed,  the  others  escaping.  Per- 
sons are  reported  as  having  been  killed  while  sitting  under 
a  low  tree,  notwithstanding  the  presence  of  tall  trees,  a 
lightning  rod,  and  an  iron  bridge  near  by.  Should  the 
question  ever  arise  as  to  whether  death  was  due  to  a  stroke 
of  lightning,  such  facts  as  there  having  been  a  thunder- 
storm at  about  the  supposed  period  of  death,  the  peculiar 
appearance  of  the  deceased,  the  co-existence  of  burns  and 
wounds,  the  finding  of  half-melted  buttons  and  coins, 
would  strongly  point  to  that  conclusion. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY,         07 


CHAPTER    VIII. 

Rape  upon  Children— Rape  upon  Adults— Rape  upon  the  Dead — Un- 
natural Crimes. 

Kape,  medico-legal  ly,  is  the  carnal  knowledge  of  a 
woman  forcibly  and  against  her  will.1  At  one  time  the 
punishment  for  rape  was  death,  castration,  fine,  or  im- 
prisonment. At  the  present  day  rape  is  regarded  as  a 
felony  (in  America '  at  least),  and  is  punished  by  fine 
and  imprisonment  for  a  term  of  years.  From  the  fact 
that,  as  a  general  rule,  the  crime  of  rape  is  committed 
in  the  absence  of  witnesses,  the  law  usually  admits  the 
testimony  of  the  victim  to  substantiate  the  charge.  It  is 
very  essential,  however,  that  medical  testimony  should  be 
obtained  as  corroborative  evidence,  as  probably  nine-tenths 
of  the  accusations  of  rape  are  false.  At  one  time  the  law 
demanded  proofs  of  penetration  as  well  as  emission  on  the 
part  of  the  male.  At  present  proof  is  only  required  of 
vulval  penetration,  without  the  hymen  being  necessarily 
ruptured. 

Rape  of  young  children,  as  might  be  expected,  is  far 
commoner  than  that  of  adult  women,  children  being  in- 
capable of  offering  much  resistance,  even  when  old  enough 
to  realize  the  nature  and  consequences  of  the  act.  Owing 
to  the  superstition  prevailing  in  Europe,  among  the  lower 
classes,  that  an  old  gonorrhoea  is  cured  by  intercourse  with 
a  virgin,  rape  of  young  children  is  far  more  common 
abroad  than  in  America.  If  the  victim  be  under  six- 
teen years  of  age,  her  consent  does  not  excuse  the  act. 

In  cases  of  the  insane,  idiotic,  or  only  feeble-minded, 
the  consent  of  the  female  will  not  be  accepted  as  an  excuse 
1  Guy  and  Ferrier  :  op.  cit.,  p.  59. 
7 


98  A   MANUAL   OF 

for  the  act.  Difficulty,  however,  is  sometimes  experienced 
in  determining  to  what  extent  the  reason  of  the  female 
alleged  to  have  been  overcome  is  affected.  It  may  be 
mentioned,  in  this  connection,  that  the  fact  that  a  woman  in 
a  state  of  stupor  has  been  subjected  to  rape  would  not  be 
an  excuse  for  the  act ;  neither  would  submission  from  fear 
nor  from  ignorance  of  the  nature  of  the  crime.  Further, 
even  if  the  character  of  the  woman  was  notoriously  bad, 
yet,  if  it  was  in  evidence  that  such  a  woman,  a  prostitute, 
for  example,  had  been  forced  against  her  will,  the  act  would 
be  a  rape.  But,  under  such  circumstances,  it  must  be  ad- 
mitted that  on  account  of  the  bad  character  of  the  woman 
the  evidence  would  have  to  be  very  strong  to  convict. 

In  every  alleged  case  of  rape  it  is  most  important  that 
the  medical  examiner  should  note  exactly  the  time  of 
making  his  examination,  and  also  determine,  so  far  as 
possible,  the  time  elapsing  since  the  act  was  committed,  as 
this  may  subsequently  become  important  evidence  in  prov- 
ing whether  or  not  the  woman  entered  complaint  at  once, 
and  submitted  without  delay  to  an  examination,  as  also 
in  enabling  the  defendant  to  prove  an  alibi.  The  female 
should  be  visited  by  the  medical  examiner  as  soon  as 
possible  after  the  perpetration  of  the  crime,  as  all  traces 
of  rape,  if  such  has  been  committed,  may  disappear  in 
three  or  four  days  ;  or,  in  the  event  of  the  accusation  being 
a  false  one,  the  woman  should  not  be  allowed  time  to  pro- 
duce artificially  evidences  simulating  those  of  rape.  In 
alleged  cases  of  rape,  a  medical  examination  is  not  com- 
pulsory ;  but  if  a  woman  under  such  circumstances  refuses 
to  have  an  examination  made,  that  in  itself  would  be  strong 
presumptive  evidence  against  the  truth  of  the  charge. 

In  cases  of  rape  the  medical  examiner  may  expect  to 
find  marks  of  violence  about  the  genitalia,  wounds,  bruises, 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.        99 

etc.,  on  both  the  person  of  the  woman  and  of  the  accused, 
spermatic  and  blood-stains  on  the  person  and  clothing  of 
both,  gonorrhoea  or  syphilis  in  one  or  both.  Rape  per- 
petrated upon  young  children  by  men  is  attended,  as 
might  be  expected,  on  account  of  the  great  disproportion  in 
size  of  the  sexual  organs,  with  far  more  severe  local  in- 
juries than  when  committed  upon  adult  women.  Indeed,  the 
absence  of  any  such  marks  of  violence  would  be  strong 
proof  of  the  charge  of  rape  made  being  a  false  one. 

If  a  child  be  examined  within  two  or  three  days  after 
the  commission  of  the  crime,  the  vulva  will  be  usually 
found  inflamed  and  swollen,  and  more  or  less  covered  with 
clotted  blood,  which  has  oozed  from  the  abraded  mucous 
membrane.  From  the  vagina  there  flows  a  muco-purulent, 
ropy  discharge  of  a  yellowish-green  color,  which  stains 
and  stiffens  the  linen.  Urination  is  frequently  painful, 
from  the  inflammation  extending  to  the  urethra.  The 
hymen  may  be  destroyed,  or  only  lacerated,  or  escape 
injury  entirely.  Too  much  importance,  however,  must 
not  be  attached  by  the  medical  examiner  to  the  presence 
or  absence  of  the  hymen  as  disproving  or  proving  a  rape. 
Indeed,  as  a  matter  of  faGt,  in  most  cases  of  rape  upon 
children,  the  hymen  escapes  injury  entirely,  probably  be- 
cause it  is  situated  in  such  cases  far  back.  On  the  other 
hand,  the  hymen  may  have  been  destroyed,  not  necessarily 
by  rape,  but  by  disease,  accident,  or  even  intentionally, 
the  object  being  in  the  latter  case  to  extort  money  by  a 
false  accusation  of  rape. 

The  vagina  is  frequently  found  very  much  dilated  in 
the  case  of  young  children  who  have  been  assaulted.  The 
medical  examiner  should  bear  in  mind,  however,  that  such 
a  dilated  condition  of  the  vagina  has  often  been  artificially 
produced  by  the  introduction  of  hard  bodies  with  the  view 


100  A   MANUAL  OF 

of  fitting  the  children  for  sexual  intercourse.  It  is  very 
important  that  the  muco-purulent  discharge  from  the 
vagina  just  referred  to  as  following  rape  should  not  be 
confounded  with  either  infantile  leucorrhoea,  gangrenous 
inflammation  of  the  vulva,  or  gonorrhoea.  Infantile 
leucorrhoea  occurs  in  unhealthy,  particularly  strumous 
children,  whose  hygienic  surroundings  are  of  the  worst 
character.  It  should  be  borne  in  mind  by  the  medical 
examiner  that  the  presence  of  such  a  discharge  in  a  young 
child  is  often  taken  advantage  of  by  an  unscrupulous 
mother  to  bring  a  charge  of  assault  against  an  innocent 
man.  Gangrenous  inflammation  of  the  vulva,  less  com- 
mon than  infantile  leucorrhoea,  is  found  among  neglected 
children  suffering  from  inanition,  exhaustion,  etc.  As  a 
general  rule,  the  absence  of  blood  and  of  bruises  in  a 
young  child  alleged  to  have  been  assaulted  would  be  strong 
proof  that  the  vaginal  discharge  was  due  rather  to  leucor- 
rhoea or  gangrenous  inflammation  than  to  the  effects  of 
violence. 

In  endeavoring  to  determine  whether  a  vaginal  discharge 
be  due  to  gonorrhoea  rather  than  to  violence,  the  medical 
examiner  should  bear  in  mind  that  a  gonorrheal  discharge 
does  not  make  its  appearance  until  between  the  fourth  and 
the  eighth  day,  and  is  usually  much  more  profuse  and  lasts 
longer  than  the  muco-purulent  discharge  incidental  to  rape. 
In  all  alleged  cases  of  rape  it  is  important  to  determine 
whether  the  accused  be  affected  with  gonorrhoea  or  syphilis, 
since  if  the  child  be  so  diseased  there  would  be  strong 
proof  of  the  guilt  of  the  accused.  It  is  possible,  however, 
that  either  gonorrhoea  or  syphilis  might  be  communicated 
to  young  children  either  accidentally  or  intentionally  by 
means  of  sponges  and  towels  that  had  been  previously  used 
by  persons  affected  with  these  diseases,  and  that  advantage 


MEDICAL    JUUISI'UIJDKNCK    AND    TOXICOLOGY. 


L01 


may  be  taken  of  this  to  accuse  an  innocent  man  of  felonious 
assault.  In  all  cases  of  alleged  rape,  the  clothing  and 
person  of  the  female  and  of  the  accused  should  be  carefully 
examined  for  seminal  stains,  which  stiffen  the  linen  or 
other  wearing  apparel  very  much  as  gum  or  albumen  will 
do.  There  are  several  methods  by  which  seminal  stains 
can  be  identified,  such  as  the  yellow  color  assumed  when 
gently  heated  or  when  dissolved  in  weak  nitric  acid  or  by 
the  odor  when  moistened  with  warm  water. 


Fig.  24. 


Fig.  25. 


Spermatozoa  of  man :  h,  apparent 
nucleus  ;  6,  body  ;  t,  tail. 


Trichomonas  vaginalis,  showiugthe 
large  heads,  with  granules  and  cilia. 


The  only  positive  proof  of  semen,  however,  is  the  pres- 
ence of  spermatozoa,  as  shown  by  the  microscope.  A 
convenient  method  of  obtaining  the  spermatozoa  for  micro- 
scopic examination  is  to  cut  out  a  piece  of  the  material 
stained  with  the  seminal  discharge  and  place  it  in  a  watch- 
glass  containing  distilled  water.  After  the  material  has 
been  thoroughly  soaked,  a  drop  of  the  liquid  should  then 
be  transferred  to  a  glass  slide,  and  the  latter  placed  on  the 
stage  of  the  microscope.  In  case  of  examining  the  hair  of 
the  female,  to  which  the  spermatozoa  cling  with  great 
tenacity,  the  hair  should  be  moistened  with  a  drop  of  weak 
ammonia  and   examined   with   the   microscope  after  the 


102  A   MANUAL   OF 

liquid  has  evaporated.  The  spermatozoa  (Fig.  24)  present 
a  very  characteristic  appearance  when  viewed  with  the 
microscope,  though  resembling  somewhat  the  flagellate  in- 
fusoria, for  which  they  were  mistaken  when  first  discovered. 
A  spermatozoon  consists  of  an  ovoidal  head,  which  tapers 
into  a  filamentary  appendage  or  tail,  about  ten  times  as 
long  as  the  head,  and  which,  when  the  spermatozoon  is 
alive,  vibrates  with  astonishing  rapidity.  The  spermatozoa 
vary  in  number  and  size,  measuring  on  an  average  between 
the  5~5-oth  and  the  -g^th  of  an  inch.  The  movements  of 
the  spermatozoa  are  arrested  by  water  and  cold,  retarded 
by  acids,  and  stimulated  by  alkalies.  The  spermatozoa 
retain  individual  life  long  after  the  death  of  the  body ; 
they  may  be  seen  moving  about  so  long  as  from  eighty  to 
one  hundred  hours  after  death.1  Indeed,  if  the  vaginal 
mucus  be  examined  even  a  week  after  sexual  intercourse, 
the  spermatozoa  may  be  sometimes  found  still  living  and 
quite  active.  In  the  dried  condition  the  spermatozoa  may 
be  identified  years  after  death. 

Spermatozoa  are  found  in  the  semen  of  man  from  the  age 
of  puberty  to  a  very  advanced  period  of  life — ninety  years 
and  upward.  Spermatozoa  are  often  absent,  however,  in 
the  semen,  for  example,  in  that  of  young  men  addicted 
to  excessive  venery  or  suffering  from  debilitating  diseases. 
The  absence  of  spermatozoa  from  stains  cannot,  then,  be 
regarded  as  proof  that  such  stains  are  not  seminal  in 
origin.  In  old  seminal  stains,  as  the  spermatozoa  are  fre- 
quently found  in  fragments,  the  medical  examiner  should 
be  extremely  cautious  under  such  circumstances  in  not  mis- 
taking for  them  the  fibres  of  organic  bodies  that  might  acci- 
dentally be  present.  The  only  living  animalcule  that  might 
be  mistaken  for  a  spermatozoon  is  the  trichomonas  vagi- 
1  Taylor:  op.  cit.,  p.  669. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.       103 

nalis  (Fig.  25)  occasionally  found  in  the  vaginal  mucus  of 

uncleanly  females.  The  trichomonas  vaginalis  is,  however, 
readily  distinguished  from  a  spermatozoon,  in  that  its  head 
is  much  larger,  granular,  and  armed  with  a  row  of  from 
four  to  six  cilia.  In  connection  with  the  subject  of  the 
rape  of  children,  it  should  be  mentioned  that  death  not 
unfrequently  results  from  mortification  or  peritonitis  brought 
on  by  violent  laceration  of  the  vagina  or  perineum. 

Rape  upon  Adult  Women. — In  cases  of  alleged  rape 
upon  adult  women,  the  medical  examiner  may  be  ques- 
tioned as  to  the  possibility  of  a  healthy,  vigorous  adult 
woman  being  overcome  by  one  man.  No  positive  an- 
swer should  be  giveu  to  so  general  a  question,  as  all 
such  cases  must  be  judged  according  to  particular  cir- 
cumstances. The  relative  size  of  the  man  and  woman, 
whether  the  woman's  life  had  been  threatened,  her  con- 
dition at  the  time,  whether  she  was  in  full  possession  of  her 
faculties,  or  stupefied  by  drink,  whether  narcotized,  hyp- 
notized, or  under  the  influence  of  anaesthetics,  must  all 
be  taken  into  careful  consideration  before  the  examiner 
commits  himself  to  the  expression  of  a  positive  opinion. 
The  question  has  often  been  asked  of  the  medical  expert 
whether  a  woman  could  be  raped  while  asleep.  The 
Medical  Faculty  of  Leipsic  decided  in  1669  that  question 
in  the  affirmative:  "dormientem  in  sella  virgiuem  insciam 
deflorari  posse."  Notwithstanding,  it  seems  incredible 
that  a  woman  could  sleep  so  soundly  as  to  be  unconscious 
of  having  sexual  intercourse.  Such,  indeed,  was  the 
opinion  of  Valentin,  who,  in  commenting  upon  the  above 
decision,  shrewdly  observes:  "  Non  omnes  dormiunt  qui 
clausos  et  conniventes  habent  oculos." x 

1  Valentini,  Michaelis  Bernhardi:  Novellas  Medieo-legcdes,  Frankfort 
ad  Moenuni,  1711,  Introd.  Part  II.,  pp.  30,  31. 


104  A   MANUAL  OP 

It  should  be  mentioned,  in  this  connection,  that  excit- 
able, emotional  women,  under  the  influence  of  ether  and 
chloroform,  especially  if  the  period  be  that  of  their  menses> 
are  very  apt  to  imagine  that  they  are  having  sexual  inter- 
course with  their  husbands,  lovers,  or  even  with  the  sur- 
geon or  dentist  who  may  be  operating  upon  them.  So 
true  is  this  that  it  is  of  the  utmost  importance  for  surgeons 
and  dentists  to  insist  upon  the  presence  of  witnesses  during 
the  performance  of  operations  upon  women  under  the  in- 
fluence of  anaesthetics.  Indeed,  in  the  absence  of  witnesses 
under  such  circumstances,  professional  men  have  been 
charged  and  convicted  of  rape,  though  without  doubt  en- 
tirely innocent  of  the  crime,  and,  extraordinary  as  it  may 
appear,  even  though  the  women  were  never  at  any  time 
examined  medically.1  Unfortunately,  in  the  case  of  alleged 
rape  upon  adult  women,  the  medical  examination  usually 
made  is  postponed  so  long  that  even  if  the  crime  has  been 
committed  all  traces  of  it  have  disappeared.  If  the  woman 
has  offered  much  resistance,  bruises  will  usually  be  found 
upon  the  thighs  and  legs,  and  sometimes  also  upon  the 
arms  and  trunk.  The  most  important  proofs  of  rape  upon 
adult  women  are,  however,  derived  from  the  condition  of 
the  sexual  organs  and  the  hymen,  and  the  presence  of  blood 
and  semen.  Among  such  proofs  may  be  mentioned  the 
soreness,  swelling,  laceration  of  the  vulva  and  vagina, 
rupture  of  the  hymen,  the  presence  of  blood  and  semen 
upon  the  persons  and  clothes  of  the  woman  and  man. 

But  it  must  be  remembered  that  frequently  women 
affected  with  leucorrhoea  or  vaginitis,  in  both  of  which  dis- 
eases there  is  a  discharge  from  the  vagina  simulating  that 
produced  by  violence,  take  advantage  of  their  condition  to 
charge  innocent  men  with  having  committed  rape  upon 
1  Philadelphia  Medical  Examiner,  December,  1854,  p.  705. 


MEDICAL  JUKISPKUDENCE  AND  TOXICOLOGY.      105 

them.  Further,  while  the  discharge  in  leucorrhcea  is 
mucous  in  character,  that  of  intense  vaginitis  may  be  so 
purulent  as  to  make  it  impossible  to  distinguish  it  from 
that  of  gonorrhoea.  Under  such  circumstances,  the  fact 
that  a  man  has  gonorrhoea  would  not  be  proof  that  he  had 
committed  an  assault  upon  the  woman  charging  him  with 
rape,  since  the  purulent  discharge  in  the  woman  might  be 
due  to  vaginitis  rather  than  to  gonorrhoea  acquired  from 
the  man. 

In  the  case  of  alleged  rape  upon  adult  women,  as  upon 
children,  much  importance  cannot  be  attached  to  the  pres- 
ence or  absence  of  the  hymen  as  disproving  or  proving  a 
rape,  for  the  reasons  already  given.  If  there  be,  however, 
other  signs  of  violence,  a  ruptured  or  lacerated  hymen 
would  be  strong  corroborative  evidence  of  a  rape  having 
been  committed. 

Rape  upon  the  Dead. — Occasionally  the  medical  exam- 
iner may  be  called  upon  to  determine  whether  a  woman 
found  dead  had  been  violated  before  death.  In  the  absence 
of  witnesses,  and  in  view  of  the  fact  that  the  prosecutrix  can 
make  no  statement,  the  evidence  will  be  necessarily  entirely 
of  a  medical  character.  But  in  such  cases,  even  if  all  the 
signs  of  sexual  intercourse  were  present,  it  would  be  im- 
possible for  the  medical  examiner  to  state  whether  the 
woman  had  or  had  not  given  her  consent.  Even  on  the 
supposition  that  the  woman  had  been  violated  before  death, 
it  might  be  impossible  to  state  positively  whether  the  rav- 
isher  and  the  murderer  were  one  and  the  same  person. 
Indeed,  a  woman  found  dead  and  violated  may  have  been 
murdered  first  and  violated  afterwards,  and  not  necessarily 
by  the  same  person,  for,  horrible  as  the  thought  may  be, 
violation  of  the  dead  is  less  rare  than  might  be  supposed. 
Indeed,  it  was  of  such  common  occurrence  in  ancient  times 
that  classical  writers  refer  to  the  necessity  of  undertakers 


106  A   MANUAL,  OF 

being  watched  to  prevent  them  violating  the  bodies  of 
women  committed  to  their  charge.  In  the  case  of  very 
young  girls  found  dead  and  violated,  the  probability  is 
that  the  child  had  been  ravished  and  then  murdered,  the 
ravisher  hoping  by  that  means  to  escape  the  consequences 
of  his  crime. 

It  would  hardly  be  supposed  that  a  rape  could  or  would 
be  committed  by  a  female  upon  a  male.  As  a  matter  of 
fact,  nevertheless,  such  cases  have  occurred. 

Unnatural  Grimes. — Though  not  germane  to  the  subject 
of  this  section,  crimes  against  nature,  committed  either 
with  man  or  beast,  unnatural  crimes,  sodomy,  psederastia, 
tribadism,  bestiality,  may  as  appropriately  be  considered 
in  their  medico-legal  relations  here  as  elsewhere.  While 
of  frequent  occurrence  in  the  East,  such  practices  are 
rare  in  America,  and  are  criminal  and  punishable  by 
imprisonment  for  a  term  of  years.  In  cases  of  sodomy 
both  parties  are  held  to  be  equally  guilty,  unless  the 
person  on  whom  the  act  was  committed  refused  consent, 
or  was  a  minor,  an  idiot,  or  feeble-minded.  In  recent 
cases  laceration  of  the  sphincter  ani,  bruises  and  fis- 
sures, and  blood  about  the  anus  may  be  observed.  Un- 
less, however,  the  examination  be  made  very  soon  after 
perpetration  of  the  act,  all  traces  will  have  disappeared. 
Characteristic  appearances  are  presented  by  persons  addicted 
to  such  practices.  Among  the  most  conspicuous  may  be 
mentioned  a  funnel-shaped  condition  of  the  anus,  which  is 
usually  enlarged,  smooth,  and  destitute  of  ruga?.1  Chancres 
and  venereal  warts  are  also  not  uncommonly  present. 

1  "Multo  magis  frequentem  tarn  nefande  coitus  usum  significare 
poterit  ipsius.  Podicis  constitutio,  qui  cum  ex  Natura  rugosus  existat, 
ex  hnjus  modi  congressu  laevis,  ac  planus  efficitur,  obliterantur  enim 
rugae  illse  in  ani  curriculo  existerites,  ob  assiduam  membri  attritionem  " 
(Zacchias,  Pauli:  a,  Quaestionum  Medico-legqlium,  Lib.  v.,  Tit.  i.,  Quaest. 
i.,  p.  383;  b,  Lib.  ii.,  Tit.  ii.,  Quaest.  ii.,  p.  288). 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      107 


CHAPTER  IX. 

Signs  of  Pregnancy — Uncertainty  of  Duration  of  Pregnancy — Preco- 
cious Pregnancy — Unconscious  Pregnancy — Pregnancy  in  the  Dead. 

The  subject  of  pregnancy  is  an  important  one  medico- 
legally,  as  women,  on  the  one  band,  frequently  deny  that 
they  are  pregnant,  in  order  to  avoid  disgrace  or  to  procure 
an  abortion,  and  on  the  other  hand  as  often  affirm  that 
they  are  pregnant,  having  no  reason  to  think  that  they  are 
in  that  condition,  in  order  to  extort  money,  to  defraud  the 
heir-at-law,  to  stay  capital  punishment,  to  avoid  attendance 
upon  a  trial,  etc.  Actions  for  damages  against  physicians 
and  others  involving  questions  of  pregnancy  often  arise  in 
cases  in  which  it  is  claimed  that  errors  in  diagnosis  were 
committed,  or  that  slanderous  reports  were  circulated 
against  the  character  of  a  virtuous  woman.  A  pregnant 
female  was  exempted  by  the  old  Roman  law  from  capital 
punishment,1  and  the  law  is  the  same  in  most  modern 
countries.  Hence,  the  summoning  of  twelve  matrons  or 
discreet  women  in  old  times  under  the  writ  of  de  ventre 
inspiciendo  to  determine  whether  a  woman  was  pregnant 
or  quick  with  child — an  office  now  performed  by  the  city's 
physician  or  by  a  jury  of  physicians. 

The  signs  of  pregnancy  may  be  described  as  being  of 
two  kinds  :  uncertain  and  certain.  The  former  kind,  as 
the  name  implies,  is,  from  a  medico-legal  point  of  view  at 
least,  but  of  little  importance  as  compared  with  the  latter. 

1  "Quod  prsegnatis  muiieris  danmata?  poena  differatur  quoad  pariat" 
(Beck,  op.  cit.,  vol.  i.  p.  250). 


108  A   MANUAL   OF 

Among  the  uncertain  signs  of  pregnancy  may  be  men- 
tioned the  suppression  of  the  catarnenia,  morning  sickness, 
enlargement  of  the  abdomen,  quickening,  development 
of  the  breasts,  kiesteine  in  the  urine,  the  violet  color 
of  the  vagina. 

Suppression  of  the  menses,  when  occurring  after  inter- 
course, only  in  a  woman  who  had  hitherto  been  regular, 
may  be  regarded  as  a  very  probable  sign  of  pregnancy. 
As  the  menses  may  continue,  however,  throughout  preg- 
nancy, as  they  may  only  appear  during  that  condition,  as 
they  may  never  appear  at  all,  even  in  women  who  bear 
children,  and  as  they  are  also  absent  in  certain  diseases,  it 
is  evident  that  neither  their  absence  nor  their  presence  can 
be  regarded  as  a  proof  of  pregnancy  or  non-pregnancy. 
But  it  should  be  mentioned  that  not  unfrequently  women 
desiring  to  conceal  their  pregnancy  stain  their  linen  with 
blood  and  even  with  menstrual  blood,  borrowed  for  that 
purpose. 

Nausea  is  usually  an  accompaniment  of  pregnancy, 
occurring  frequently  as  early  as  the  second  or  third  week 
after  conception.  It  generally  passes  away  about  the 
time  of  quickening,  but  may  continue  throughout  the 
whole  period  of  pregnancy.  In  many  cases  of  pregnancy 
nausea  is  absent ;  on  the  other  hand,  it  is  of  frequent 
occurrence  in  many  diseases.  But  little  importance  can 
therefore  be  attached  to  nausea  alone  as  a  sign  of  preg- 
nancy. 

The  enlargement  of  the  abdomen  in  a  pregnant  woman 
becomes  evident  at  the  end  of  the  third  month,  the 
uterus  then  rising  out  of  the  pelvic  cavity.  By  the  end 
of  the  fifth  month  the  uterus  is  halfway  between  the 
pelvis  and  the  umbilicus,  and  at  the  sixth  month  at  the 
umbilicus.     During  the  seventh  month  it  is  at  a  point 


MEDICAL   JURIS  PRUDE  NO  K    AND   TOXICOLOGY.      109 

midway  between  the  umbilicus  aud  ensiform  cartilage, 
reaching  at  the  end  of  the  eighth  month  the  ensiform 
cartilage.  During  the  last  month  the  tumor  widens  and 
falls  forward.  Enlargement  of  the  abdomen  may  be  due, 
however,  to  ovarian  dropsy  and  tumors,  ascites,  flatus  of 
the  intestines,  impacted  feces,  enlargement  of  the  spleen 
and  kidney,  and  distention  of  the  bladder.  The  medical 
examiner  would  certainly  not  be  justified,  therefore,  in 
expressing  the  opinion  that  a  woman  was  pregnant  simply 
because  there  was  enlargement  of  the  abdomen. 

Quickening  is  the  first  perception  by  the  mother  of  the 
movements  of  the  foetus.  These  movements,  which  occur 
usually  some  time  between  the  sixteenth  and  the  twenty- 
fourth  week,  may  be  due  either  to  the  uterus  or  to  the 
foetus.  Nervous,  excitable  women,  especially  those  want- 
ing children,  frequently  imagine,  however,  they  are  preg- 
nant, mistaking  the  movements  of  their  intestines  or 
the  contractions  of  their  abdominal  muscles  for  those 
of  a  foetus.  Quickening,  being  entirely  a  subjective 
symptom,  is,  therefore,  a  very  unreliable  sign  of  preg- 
nancy. 

The  breasts  usually  develop  during  the  period  of  preg- 
nancy, becoming  larger  and  fuller  as  the  secretion  of  milk 
increases.  Large  veins  make  their  appearance,  the  nipples 
become  more  prominent,  the  areola  widens  and  darkens  in 
hue,  especially  in  brunettes.  Enlargement  of  the  breasts, 
however,  is  not  a  proof  of  pregnancy,  inasmuch  as  it  occurs 
in  cases  of  uterine  fibroids,  and  in  various  other  ovarian 
aud  uterine  disorders.  Even  the  secretion  of  milk  would 
not  warrant  the  statement  that  a  woman  was  pregnant, 
since  milk  is  secreted  occasionally  by  unimpregnated 
women,  young  girls,  and  even  by  men.  Indeed  there  have 
been  cases  in  which  the  secretion  of  milk  bv  men  has  been 


110  A   MANUAL  OF 

so  copious  that  they  have  been  able  to  perform,  for  years, 
the  office  of  wet-nurse.1 

By  kiesteine  is  understood  the  fatty  pellicle  which  forms 
on  the  urine  of  pregnant  women  that  has  been  standing 
some  days.  It  appears  to  consist  of  a  combination  of 
casein  and  phosphates.  As  kiesteine  is  not  peculiar  to  the 
urine  of  pregnant  women,  being  found  sometimes  in  the 
urine  of  men,  its  presence  cannot  be  regarded  as  a  proof 
of  pregnancy.  The  violet  color  of  the  vagina,  appearing 
about  the  fourth  week  of  gestation,  due  to  venous  conges- 
tion, may  be  regarded  as  a  valuable  sign  of  pregnancy, 
but  an  uncertain  one,  since  it  is  not  invariably  present. 

Ballottement. — Among  the  so-called  "positive  signs"  of 
pregnancy  are  included  ballottement,  change  in  the  body 
and  cervix  of  the  uterus,  the  active  movements  of  the 
child,  the  pulsation  of  the  foetal  heart,  the  uterine  and 
umbilical  sounds.  By  ballottement  is  determined  the  pres- 
ence of  a  foetus  about  the  fifth  or  sixth  month  of  pregnancy. 
In  performing  it,  the  woman  is  made  to  stand  upright  and 
the  finger  of  one  hand  is  introduced  into  the  vagina  up  to 
the  os  uteri,  while  the  other  hand  is  placed  upon  the  abdo- 
men, so  as  to  steady  the  uterine  tumor.  If  the  tip  of  the 
finger  be  now  suddenly  pushed  up  against  the  os  uteri,  a 
sensation,  should  a  foetus  be  present,  will  be  felt  like  that 
of  a  body  rising  and  falling  in  a  liquid.  This  is,  how- 
ever, an  uncertain  sign  of  pregnancy,  since  any  floating 
tumor  in  the  uterus  will  impart  the  same  sensation  to  the 
finger  as  that  due  to  the  foetus. 

At  about  the  fifth   month  of  pregnancy,  the  os  uteri 

is  directed  backwards,  and  has  a  velvet-like  feeling ;  the 

shortening  of  the  cervix  becomes  evident  at  this  time  and 

continues  until  the  ninth  month,  when  the  cervix  ceases 

1  Dunglison  :  Human  Physiology,  eighth  edition,  vol.  ii.  p.  520. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      Ill 

to  be  distinguishable  from  tlic  body  of  the  uterus.  The 
active  motions  of  the  child  can  usually  be  felt  about 
the  fifth  month  of  pregnancy,  or  even  earlier,  by 
placing  a  cold  hand  upon  the  surface  of  the  abdomen. 
Intestinal  movements  must  not  be  mistaken,  however, 
for  those  of  a  foetus.  It  should  be  remembered  also  that 
not  unfrequently  in  cases  of  pregnancy  the  movements 
of  the  foetus  are  not  perceptible. 

The  uterine  sound,  a  peculiar  blowing  or  whistling 
sound,  synchronous  with  the  maternal  pulse,  and  due 
probably  to  the  passage  of  blood  through  the  uterine 
arteries  and  placental  vessels,  can  usually  be  heard  over 
most  of  the  abdomen  as  early  as  the  middle  of  the  third 
month  of  pregnancy,  but  more  distinctly  as  pregnancy 
advances.  As  uterine  sounds  can,  however,  be  heard  in 
cases  of  enlargement  of  the  uterus  as  from  tumors,  such 
signs  are  very  unreliable  signs  of  pregnancy,  and  the  same 
may  be  said  of  the  umbilical  sounds  due  to  the  flow  of 
blood  through  the  umbilical  vessels. 

Pulsation  of  the  Foetal  Heart. — Indeed,  of  all  the  so- 
called  "  certain  signs  "  of  pregnancy,  the  pulsation  of  the 
foetal  heart  is  the  only  certain  and  positive  one,  and  then 
only  when  it  can  be  so  distinctly  heard  as  to  be  counted. 
The  foetal  sound  is  not  synchronous  with  the  pulse  of  the 
mother,  the  foetal  heart  beating  at  a  rate  of  one  hundred 
and  thirty-six  beats  to  the  minute,  and  even  faster.  It 
resembles  the  ticking  of  a  watch,  and  is  heard  over  different 
parts  of  the  abdomen,  but  best  between  the  ilium  and  the 
umbilicus  on  either  side.  It  may  be  heard  as  early  as 
the  middle  of  the  fifth  month,  but  much  more  distinctly 
as  pregnancy  advances.1 

1Scanzoni:  Lehrbueh  der  Geburtshulfe,  Vierte  Auflage,  "Wien,   1867, 
vol.  i.  S.  160. 


112  A   MANUAL   OF 

Corpus  Luteum. — Importance  was  attached  at  one  time 
to  the  presence  or  absence  of  a  corpus  luteum,  or  the  yellow 
body  developed  through  modification  of  the  lining  mem- 
brane and  contents  of  the  Graafian  follicle  from  which  an 
ovum  had  escaped,  as  proving  or  disproving  pregnancy. 
A  foetus  is  not  unfrequently  found,  however,  in  the  uterus 
where  there  is  no  trace  of  a  corpus  luteum  in  either  ovary  ■ 
and,  on  the  other  hand,  a  well-developed  corpus  luteum, 
undistinguishable  from  that  of  pregnancy,  may  be  found 
in  the  ovary  of  a  woman  who  had  never  been  pregnant, 
and  even  in  that  of  a  virgin.  The  presence  or  absence 
of  a  corpus  luteum  cannot  then  be  regarded  as  having 
any  importance  in  medico-legal  cases  involving  questions 
of  pregnancy. 

Responsibility  of  Mistaken  Diagnosis. — As  the  so-called 
"certain  signs"  of  pregnancy,  with  the  exception  of  the 
pulsation  of  the  foetal  heart,  are  only  relatively  more  cer- 
tain than  the  uncertain  signs,  the  medical  examiner  should 
be  extremely  cautious,  under  any  circumstances,  in  stating 
positively  that  a  woman  is  pregnant,  and  especially  if  she 
be  unmarried  and  of  previously  good  character.  On  more 
than  one  occasion  has  the  reputation  of  a  virtuous  woman 
been  ruined  and  the  happiness  of  her  family  destroyed  by 
a  too  confident  examiner  mistaking  a  condition  of  disease 
for  that  of  pregnancy.  When  once  the  virtue  of  an  inno- 
cent woman  has  been  thus  impugned,  and  her  previously 
good  character  taken  away,  though  in  time  the  injustice 
of  the  charge  will  surely  be  proved,  reparation  will  come 
too  late,  and  no  atonement  can  be  made  for  the  wrong 
done  the  woman  or  the  misery  inflicted  upon  her  family. 
Apart  from  the  injury  due  to  a  mistake  in  diagnosis  under 
such  circumstances,  the  examiner  should  remember  that  as 


Plate  l. 


Fig.  1.— Ovary  of  woman  two  days  after  menstruation,  showing  earliest  stages  of  trans- 
formation of  a  ruptured  and  bloody  Graafian  follicle  into  a  corpus  luteum. 

Fig.  2.— Ovary  of  woman  nine  days  after  menstruation:  the  dark  spot  is  the  cicatrice- 
the  surrounding  yellow  circle  is  the  corpus  luteum  shining  through  the  transparent  tissue" 

Fig.  3.— Ovary  of  woman  at  term  of  pregnancy,  showing  corpus  luteum  with  firm  white 
central  clot. 

Fig.  4.— Ovary  of  woman  twenty  davs  after  menstruation:  besides  laree  fresh  corpus 
luteum  are  seen  two  smaller  old  ones,  and  Graafian  follicles  of  different  sizes  (Daltox). 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      1  L'3 

the  best  obstetricians  may  be  mistaken,  his  own  reputation 
as  a  medical  expert  may  be  at  stake. 

Cases  of  supposed  pregnancy  differ  in  one  respect  from 
other  cases  demanding  the  attention  of  the  medical  jurist 
— namely,  there  is  no  necessity  that  a  positive  opinion 
should  be  expressed  upon  the  subject.  No  harm  can  result 
from  the  medical  examiner  refusing  to  state  positively 
whether  a  woman  is  pregnant  or  not.  It  is  far  better  to 
give  the  woman,  if  unmarried  and  of  good  character,  the 
benefit  of  the  doubt,  than  positively  commit  yourself  to 
the  expression  of  an  erroneous  opinion  in  the  case.  It 
should  always  be  remembered  that  nature  will  soon  answer 
so  positively  the  question  whether  a  woman  is  or  is  not 
pregnant  that  there  will  be  no  necessity  of  the  examiner 
weighing  the  relative  value  of  the  uncertain  and  certain 
signs  of  pregnancy. 

Duration  of  Pregnancy. — The  determination  of  the  dura- 
tion of  pregnancy  under  certain  circumstances,  as  in  cases 
involving  questions  of  legitimacy  and  inheritance,  may  be- 
come a  matter,  medico-legally,  of  the  greatest  importance. 
It  may  as  appropriately  be  mentioned  here  as  elsewhere  that 
the  ordinary  period  of  gestation  is  nine  calendar  months 
(270  to  276  days),  or  ten  lunar  months  (280  days),  the  physi- 
ological presumption  being  that  parturition  occurs  at  the 
period  which  would  correspond  to  the  tenth  menstrual  pe- 
riod since  the  last  one.  The  greatest  difference  of  opinion 
prevails,  however,  as  to  what  shall  constitute  the  longest 
and  shortest  possible  periods  of  gestation.  The  difference 
of  opinion  in  this  respect  depends  to  a  great  extent  upon 
our  ignorance  as  to  the  exact  moment  of  conception.  As 
conception  may  take  place  at  any  moment  of  the  period 
intervening  between  the  menses,  it  is  evident  that  there 
may  be  a  difference  on  this  account  alone  of  twenty-eight 
8 


114  A    MANUAL    OF 

days  in  the  period  of  gestation,  according  as  conception  was 
supposed  to  have  taken  place  immediately  before  the  period 
at  which  the  menses  would  have  occurred  had  not  concep- 
tion taken  place,  or  immediately  after  the  last  menses 
which  actually  did  occur.  Further,  the  duration  of  preg- 
nancy varies  very  much  in  different  women  on  account  of 
personal  idiosyncrasies,  as  well  as  on  account  of  other 
causes  not  understood.  Obstetricians  have  claimed  that 
mature  children  have  been  born  as  early  as  from  210 
to  217  days,1  and  as  late  as  from  313,  even  to  325, 
days  after  sexual  intercourse,  there  being  a  difference 
between  these  very  exceptional  extremes  of  as  much  as 
96  days.  Cases  are  not  rare,  however,  in  which  the 
difference  in  the  duration  of  gestation  in  cases  of  mature 
children  amounts  to  as  much  as  44  days,  the  two  ex- 
tremes of  gestation  being  249  and  293  days  respectively. 
It  should  be  mentioned  in  this  connection  that  while  a  child 
born  after  a  period  of  protracted  gestation  is  neither  larger 
nor  better  developed  than  one  born  after  the  average  period, 
a  child  born  only  seven  months  after  sexual  intercourse  is 
always  immature  and  imperfect — readily  distinguishable 
from  one  born  after  the  average  period.2  It  is  for  this 
reason  that  the  statement  that  a  mature  child  is  born  seven 
months  after  sexual  intercourse  must  be  regarded  as  most 
exceptional.  In  tropical  countries  women  become  preg- 
nant at  a  much  earlier  age  than  in  temperate  climes.  Thus, 
in  India  and  Abyssinia  it  is  no  uncommon  occurrence  for 
girls  of  only  eleven  and  twelve  years  of  age  to  bear  children. 
Pregnancy  has  been  known  to  occur,  however,  even  in 
children  of  only  eight  and  nine  years  of  age.    On  the  other 

1  Beck :  op.  cit.,  vol.  i.  p.  599. 

2  Montgomery :   Signs  and  Symptoms  of  Pregnancy,  second  edition, 
London,  1856,  pp.  523,  546. 


MEDICAL  JURISPRUDENCE   AND   TOXICOLOGY.      L15 

hand,  it  is  well  known  that  women  of  from  fifty  to  sixty 
years  of  age  and  even  older  have  borne  children,  giving 
birth  to  twins,  in  some  rare  instances,  even  at  that  advanced 
age. 

Unconscious  Pregnancy. — Under  certain  circumstances 
it  may  become  a  question  whether  a  woman  can  become 
pregnant  while  unconscious.  There  can  be  no  doubt  of  the 
possibility  of  such  an  occurrence,  as  it  is  well  known  that 
women  have  borne  children  in  consequence  of  having 
been  ravished  when  in  a  state  of  unconsciousness  induced 
by  the  use  of  narcotics  or  anaesthetics. 

Pregnancy  in  the  Dead. — It  not  unfrequently  occurs  that 
the  medical  examiner  is  required  to  determine  whether  a 
woman  was  pregnant  at  the  time  of  her  death,  as,  for  exam- 
ple, in  cases  where  the  charge  is  that  of  seduction  and  murder. 
In  considering  the  subject  of  putrefaction,  it  will  be  remem- 
bered that  attention  was  called  to  the  remarkable  fact  that 
the  unimpregnated  uterus  will  resist  decomposition  longer 
than  any  other  organ  in  the  body  months  after  burial ; 
therefore,  it  becomes  possible  to  say  whether  a  woman  died 
pregnant  or  not.  On  the  other  hand,  even  after  years  of 
interment,  if  the  woman  died  pregnant  and  the  foetus  had 
reached  the  period  of  ossification,  traces  of  its  bones  will 
be  found  among  those  of  its  mother. 


116  A   MANUAL   OF 


CHAPTER  X. 

Foeticide — Development  of  Embryo — Formation  of  Placenta,  of  Moles 
— Changes  Undergone  by  the  Uterus  during  Pregnancy — Of  the 
Means  of  Producing  Foeticide — Abortion  from  Natural  Causes. 

The  unlawful  expulsion  of  the  foetus  constitutes  foeticide, 
or  criminal  abortion.  By  the  term  abortion  or  miscarriage 
is  understood,  medically,  the  expulsion  of  the  foetus  before 
the  seventh  calendar  month  of  gestation ;  that  is,  before  it  is 
viable  or  would  survive.  After  this  period  the  expulsion 
is  called  "  premature  labor."  Legally,  however,  such  a  dis- 
tinction is  not  made;  the  unlawful  expulsion  of  the  foetus  at 
any  period  of  gestation  being  regarded  as  abortion.  At  one 
time  the  law  also  recognized  a  distinction  between  an  abor- 
tion produced  before  and  after  quickening,  the  punishment 
being  more  severe  in  the  latter  than  in  the  former  instance. 
At  the  present  time  the  criminality  of  the  act  is  the  same, 
whatever  may  be  the  period  of  gestation  at  which  the 
abortion  is  committed. 

Foeticide,  although  an  extremely  common  crime,  rarely 
becomes  the  subject  of  trial  unless  it  involves  the  death  of 
the  mother,  in  which  case  it  is  regarded  as  murder.  The 
proofs  that  a  criminal  abortion  has  been  committed  are 
derived  from  the  condition  of  the  foetus  or  fcetal  remains, 
whether  expelled  from  the  uterus  or  still  retained  within 
it,  and  from  the  condition  of  the  mother. 

Development  of  the  Human  Embryo. — The  human  em- 
bryo,1 at  one  of  the  earliest  periods  of  development  yet 
obtained,  that  is,  about  from  ten  to  fourteen  days  after  con- 
ception, consists  (Fig.  26)  of  a  tube,  the  primitive  neural 
canal,  more  or  less  open  on  top;  from  the  under  part  of 

1  Haeckel :  Anthropogenie,  Vierte  Auflage,  Erster  Theil,  Leipzig,  1891, 
S.  365. 


MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY.      117 

which  hangs  a  globular-like  bag.  The  latter,  through  subse- 
quent constriction,  divides  into  an  upper  and  lower  portion 

Fig.  27. 


Fig.  26. 


Human  embryo,  natural  size,  fourteen 
days  old  (Haeckel). 

Fig.  28. 


Human  embryo,  magnified  ten 
times,  about  ten  days  old :  a,  um- 
bilical vesicle ;  c,  b,  d,  primitive 
spinal  cord ;  e,  remains  of  amnion 
(Haeckel). 


Human  embryo,  natural  size,  three 
weeks  old  (Haeckel). 

continuous  with  each  other,  which  become  respectively  the 
primitive  alimentary  canal  and  the  umbilical  vesicle. 

The  embryo,  not  longer  than  the  one-twelfth  of  an  inch, 
and  inclosed  within  the  amniotic  folds,  does  not  lie  naked 
within  the  uterus ;  but  within  the  zona  pellucida  (Fig.  27)  or 
the  original  membrane  which  inclosed  the  yelk,  or  the  con- 
tents of  the  egg.  The  zona  pellucida  being  covered,  however, 
with  little  villous-like  processes,  is  now  known  and  hence- 
forth as  the  chorion.  By  the  21st  day  of  uterine  life  the 
embryo  (Figs.  28,  29),  having  attained  a  length  of  about  the 


118 


A   MANUAL   OF 


one-sixth  of  an  inch,  rudimentary  eyes  and  ears,  the  mouth, 
three  cerebral  vesicles,  bronchial  arches  and  clefts,  umbilical 
vesicle,  allantois  and  amnion  are  all  developed.  At  the  end 
of  the  first  month,  the  embryo,  being  one-half  an  inch 


Fig.  29. 


Fig  30. 


Human  embryo  magnified, 
three  weeks  old :  a,  eye ;  m, 
mid-brain;  o,  ear;  k,  visceral 
arches  ;  c,  heart  (Haeckel). 


Human  embryo,  natural  size,  six  weeks 
old  (Haeckel). 


long  and  weighing  perhaps  about  twenty  grains,  is  still 
further  developed  and  is  provided  with  rudimentary  limbs. 
By  the  end  of  the  sixth  week  the  embryo  (Fig.  30)  has 
grown  larger,  and  the  limbs  are  better  developed,  attaining 
at  the  end  of  the  second  month  (Fig.  32)  a  length  of  one 
inch,  and  weighing  about  one-eighth  of  an  ounce.  The 
fingers  aud  toes  are  also  now  indicated,  and  ossification 
has  begun  in  the  lower  jaw,  clavicle,  ribs,  and  vertebral 
bodies.  At  the  third  month  the  embryo  (Fig.  31)  varies 
in  length  from  2  to  4  inches  and  weighs  from  1  to  4 
ounces ;  the  sex  can  usually  be  distinguished  by  the  ex- 
ternal genitalia,  and  the  placenta  is  beginning  to  be  formed. 
Formation  of  the  Placenta. — It  will  be  observed  that  the 


Plate  'J. 


sa.ss° 

-  •-  -.  ■- 


•  -.  >  ; 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      119 

villous  processes  of  the  chorion,  which  have  hitherto  cov- 
ered the  latter  membrane  throughout  its  whole  extent,  are 
now  limited  to  that  portion  of  it  in  contact  with  the  de- 
cidua  scroti  na,  or  that  part  of  the  hypertrophied  mucous 
membrane  of  the  uterus  into  which  the  villous  process  s 

Fig.  31. 


Human  embryo,  natural  size,  three  months  old.    (Haeckel.) 

of  the  chorion  still  remaining  insinuate  themselves.  The 
fusion  of  the  two  constitutes  the  placenta  (PI.  2,  Fig.  1). 
Of  the  remaining  portion  of  the  hypertrophied  mucous 
membrane  of  the  uterus,  that  part  which  ultimately  grows 
around  the  ovum  is  known  as  the  decidua  reflcxa,  and 


120 


A   MANUAL   OF 


that  in  contact  with  the  wall  of  the  uterus,  the  decidua 
vera. 

The  villous  processes  of  the  chorion,  when  examined 
with  the  microscope,  present  so  characteristic  an  appearance 
(Fig.  33)  that  their  presence  may  be  accepted  as  positive 


Fig.  32. 


Fig.  33. 


mm.' 


Human  embryo   magnified,  eight  Compound    villosity    of    human 

weeks   old :  v,  fore-brain ;   m,   mid-  chorion,  ramified  extremity :    from 

brain;  h,  hind-brain;  n,  after-brain;  a  three  months'  foetus,  magnified 

c,  heart ;  /,  upper  extremity  ;  b,  lower  thirty  diameters     (Dalton). 
extremity ;  s,  tail  (Haeckel). 

proof  of  the  existence  of  the  embryo,  even  if  not  a  trace  of 
the  latter  be  found.1  The  general  appearance  of  a  villous 
process  is  like  that  of  a  sea-weed  originating  in  the  cho- 
rion by  a  trunk  which  divides  and  subdivides  into  filament- 
ous branches,  swollen  here  and  there,  terminating  in 
rounded  bulbous  extremities,  and  consisting  internally  of 
a  finely-granular  substance  containing  nuclei.    At  first  the 

1  Dalton,  John  C. :  Human  Physiology,  seventh  edition,  Philadelphia, 
1882,  p.  647. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      121 

villou.s  processes  of  the  chorion  arc  without  bloodvessels, 
but  with  the  development  of  the  allautois  they  become  vas- 
cular through  prolongation  of  the  terminal  allantoic  vessels, 
which  are  disposed  in  loops.  The  placenta  (PI.  2,  Fig.  2) 
or  after-birth,  consisting  essentially  of  the  interlacement  of 
the  bloodvessels  of  the  embryo  with  those  of  the  mother, 
is  a  flattened  fleshy,  vascular,  dish-like  mass,  round  or  ovoid 
in  shape  and  with  a  diameter  of  from  six  to  eight  inches. 
It  is  the  organ  by  means  of  which  food  and  oxygen  are 
conveyed  from  the  blood  of  the  mother  to  that  of  the 
embryo.  The  process  by  which  this  is  accomplished  is, 
however,  by  osmosis,  as  there  is  never  at  any  period  of 
gestation  an  anastomosis  of  the  maternal  and  foetal  blood- 
vessels. 

Such  being  the  structure  and  development  of  the  pla- 
centa, it  is  evident  that,  just  in  proportion  as  the  foetal  and 
maternal  portions  of  the  placenta  become  more  and  more 
intimately  fused  together,  the  greater  will  be  the  difficulty 
experienced  and  risk  run  in  the  expulsion  of  the  foetus  from 
the  uterus.  It  is  for  this  reason  that  an  abortion  committed 
after  the  third  month  of  gestation  may  be  attended  with  such 
fatal  consequences,  the  hemorrhage  resulting  from  the  rup- 
ture of  the  bloodvessels  being  at  times  very  great.  Indeed, 
at  a  late  period  of  gestation  the  maternal  bloodvessels  become 
dilated  into  great  sinuses,  veritable  blood  lakes.  On  the 
other  hand,  if  gestation  has  not  advanced  beyond  the  third 
month,  the  embryo  may,  under  certain  circumstances,  be 
expelled  entire  from  the  uterus,  very  much  as  a  glove  is 
removed  from  the  fingers,  without  any  serious  conse- 
quences. 

Subsequent  Changes  Undergone  by  the  Human  Embryo. — 
The  subsequent  changes  undergone  by  the  embryo  during 
the  last  six  months  of  pregnancy  are  of  interest,  medico- 


122  A   MANUAL   OF 

legally,  as  enabling  the  examiner  to  state  the  probable 
age  of  a  foetus  obtained  from  a  supposed  case  of  abortion. 
At  the  fourth  month  the  fcetus  is  5  to  6  inches  long  and 
weighs  about  3  ounces,  the  umbilical  cord  measuring 
about  7  inches  in  length.  At  the  fifth  month  the  foetus 
has  attained  a  length  of  6  to  7  inches,  weighs  from  5  to 
7  ounces,  and  is  covered  with  the  vernix  caseosa ;  the  hair 
of  the  head  and  body,  or  lanugo,  is  quite  distinct,  and 
the  umbilical  cord  is  about  12  inches  long.  If  abor- 
tion occurs  at  this  period  of  gestation,  the  membranes 
are  first  ruptured,  and  then  the  foetus  is  expelled  from 
the  uterus.  At  the  sixth  month  of  pregnancy  the  foetus 
varies  in  length  from  9  to  10  inches,  weighs  a  pound 
or  more,  and  meconium  is  usually  found  in  the  intestines. 
At  the  end  of  the  seventh  month  the  foetus  is  usually 
14  inches  long,  weighs  two  and  a  half  to  three  pounds, 
the  eyes  are  open,  the  membrane  of  the  pupil  is  disappear- 
ing, one  testicle  has  descended  into  the  inguinal  canal.  If 
the  child  should  be  born  at  this  period,  the  arms  and  legs 
will  be  bent  in  the  position  they  assumed  in  the  womb, 
and  it  will  be  viable.  At  the  eighth  month  the  foetus  is 
sixteen  inches  long,  weighs  between  three  and  four  pounds  ; 
the  skin  has  become  thicker,  and  is  covered  with  fine  soft 
hair ;  one  testicle,  usually  the  left,  has  descended  into  the 
scrotum.  At  the  end  of  the  ninth  month,  or  at  full  term,  the 
foetus  varies  in  length  from  eighteen  to  twenty  inches,  and 
weighs  on  an  average  seven  pounds.  The  intestines  are 
nearly  filled  with  meconium;  the  bladder  contains  urine; 
both  testicles  have  descended  into  the  scrotum. 

As  aiding  in  determining  the  age  of  the  foetus,  it  may  be 
mentioned  that  at  full  term  the  umbilical  cord  is  usually 
inserted  about  eight  to  ten  lines  below  the  centre  of  the 
body ;  whereas,  at  an  earlier  period  of  gestation,  the  point 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      123 

of  insertion  is  at  the  middle  of  the  body.  The  general 
development  of  the  brain,  the  extent  to  which  the  cere- 
bellum is  covered  by  the  cerebrum,  the  particular  fissures 
that  are  present  will  also  serve  to  determine  the  age  of  the 
foetus.  The  importance  of  the  presence  or  absence  of  an 
osseous  deposit  in  the  inferior  epiphysis  of  the  femur  has 
already  been  referred  to  (p.  45).  It  should  be  mentioned,  in 
connection  with  the  subject  of  the  length  and  weight  of  the 
foetus  at  full  term,  that  these  may  vary  considerably.1  Thus, 
for  example,  it  is  well  known  that  children  have  been 
born  at  full  term  who  measured  as  much  as  twenty-four 
and  even  thirty-two  inches,  and  who  weighed  as  much  as 
seventeen  and  three-quarter  pounds,2  and  eighteen  pounds 
and  two  ounces,3  respectively.  On  the  other  hand,  chil- 
dren at  full  term  not  unfrequently  weigh  only  from  four 
to  six  pounds.  There  is  usually  no  difficulty  experienced 
in  recognizing  an  embryo  in  situ,  or  even  amid  the 
contents  expelled  from  a  uterus  in  cases  of  abortion, 
unless  the  latter  be  committed  in  the  very  early  periods 
of  gestation. 

Holes. — Under  certain  circumstances  the  medical  ex- 
aminer may  be  called  upon  to  determine  whether  peculiar 
growths,  either  formed  in  the  uterus  or  expelled  from  it, 
are  polypi  or  membranous  in  character,  as  due  to  dys- 
menorrhea, or  what  are  known  as  molesS  It  is  most 
important  that  the  true  nature  of  the  latter,  when  present, 
should  be  recognized,  as  moles,  being  due  to  disease  of  the 

1  As  to  variability  in  size  and  weight  presented  by  the  foetus  at  differ- 
ent periods  of  intra-uterine  life,  compare  Casper,  vol.  iii.  pp.  15-17 ; 
Guy  and  Ferrier,  p.  88;  Tidy,  part  ii.  p.  59;  Wharton  and  Stille, 
vol.  iii.  p.  75;  Woodman  and  Tidy,  pp.  647,  712. 

2  Owens :  Lancet,  December,  1838,  p.  477. 

3  Meadows :  Medical  Times  and,  Gazette,  August  4,  1860,  p.  105. 

4  Montgomery :  op.  cit.,  pp.  255,  269,  326,  353. 


124  A   MANTJAL  OF 

placenta  or  of  the  foetal  membranes,  are  as  much  proof 
of  a  pregnancy  having  existed  as  the  presence  of  the 
embryo  itself.  Moles,  when  due  to  disease  of  the  placenta, 
are  either  fleshy  or  fatty.  A  fleshy  mole  consists  of  layers 
of  a  fibrinous  material  inclosing  a  cavity  in  which  the 
remains  of  the  foetus  are  sometimes  formed.  While  the 
cause  of  fleshy  moles  is  obscure  in  some  instances,  they 
appear  to  be  due  to  hemorrhage  into  the  chorion.  A  fatty 
mole  differs  more  particularly  from  a  fleshy  one,  in  that  a 
fatty  degeneration  is  an  accompaniment  of  the  early  death 
of  the  foetus.  The  hydatiform,  or  vesicular  mole,  is  due  to 
the  villous  processes  of  the  chorion  becoming  infiltrated  with 
serum,  and  hanging  in  masses  like  bunches  of  grapes.  A 
true  hydatid — that  is,  a  helminth  of  the  uterus — is  exceed- 
ingly rare ;  indeed,  it  is  very  doubtful  if  it  has  ever  been 
found. 

The  proofs  of  an  abortion  having  been  committed,  as 
derived  from  an  examination  of  the  mother,  are  not 
very  positive,  if  the  act  has  been  performed  at  an  early 
period  of  pregnancy.  The  hemorrhage  and  relaxed  con- 
dition of  the  vagina,  for  example,  and  the  somewhat  dilated 
condition  of  the  os  uteri,  might  be  attributed  to  menstru- 
ation. If  the  pregnancy  was,  however,  far  advanced  at 
the  time  of  the  occurrence  of  the  abortion,  the  proofs  will 
usually  be  sufficiently  strong  to  establish  the  fact.  It  is 
far  more  difficult,  therefore,  for  a  woman  to  conceal  her 
pregnancy  and  the  fact  that  an  abortion  had  been  com- 
mitted to  save  her  from  exposure,  at  a  late  period  of  ges- 
tation than  at  an  early  one.  If  death  follows  within  three 
days  after  abortion,  the  post-mortem  examination  will 
generally  establish  the  fact  that  an  abortion  was  committed. 
If  several  weeks,  however,  have  elapsed,  little  or  nothing 
will  be  learned  by  the  autopsy,  as  the  parts  involved  will 


MEDICAL  JURISPRUDENCE   AND   TOXICOLOGY.      125 

have  usually  reassumed  by  that  time  their  usual  con- 
dition. 

Determination  of  Foeticide. — In  every  case  of  foeticide 
the  vagina  and  uterus  should  most  carefully  he  exam- 
ined for  metritis  and  marks  of  violence  which  might 
have  been  produced  by  the  use  of  instruments.  Wounds 
of  the  vagina  would  rather  indicate  that  they  had  not 
beeii  made  by  a  professional  abortionist,  but  by  one 
who  was  inexperienced  in  such  work  and  who  had  been 
rendered  nervous  in  attempting  to  perform  the  opera- 
tion. If  the  neck  of  the  uterus  or  its  fundus  be  found 
perforated,  or  the  placenta  wounded,  the  inference  to  be 
drawn  would  be  that  pointed  instruments  had  been  used, 
though  not  necessarily,  since  fatal  wounds  have  been 
also  inflicted  by  blunt  instruments.  The  most  common 
causes  of  death  in  cases  of  abortion  as  produced  by  instru- 
mental violence  are  hemorrhage  and  peritonitis.  The 
stomach  and  intestines  should  also  be  carefully  examined 
in  cases  of  foeticide,  as  they  present,  not  unfrequently, 
evidence  that  irritant  poisons  have  been  taken.  Remains 
of  cantharides,  tops  of  savin,  ergot  may  be  found  ;  or  the 
oils  of  savin,  tansy,  pennyroyal  may  be  recognized  by  their 
odor  or  by  appropriate  chemical  means,  such  as  distillation, 
etc.  The  shape  and  size  of  the  uterus  should  be  carefully 
noted  in  cases  of  foeticide,  as  they  enable  the  examiner  to 
determine  approximately  at  least  the  age  of  the  fcetus. 

The  normal  uterus  in  the  unimpregnated  condition  meas- 
ures about  two  and  a  half  inches  in  length,  one  inch  and  three- 
quarters  in  breadth,  and  one  inch  thick.  As  pregnancy 
advances,  the  uterus  increases  gradually  in  size — very  little 
change  being  noticeable,  however,  during  the  first  month. 
During  the  second  month,  the  increase  is  considerable, 
By  the  end  of  the  third  month  it  has  attained  a  length  of 


126 


A    MANUAL,   OF 


five  inches,  including  one  inch  for  the  cervix.  At  the  end 
of  the  fourth  month,  the  uterus  is  five  inches  long  from 
the  fundus  to  the  beginning  of  the  cervix,  and  at  the  end 
of  the  fifth,  sixth,  and  seventh  month  it  is  six,  seven,  and 
eight  inches  long,  respectively.  At  eight  months  the 
uterus  varies  in  length  from  nine  to  nine  and  a  half  inches, 
and  at  nine  months  from  between  ten  and  a  half  to  twelve 
inches  in  its  total  length.  While  the  thickness  of  the 
walls  of  the  uterus  at  full  term  is  about  the  same  as  that 
in   the    unimpregnated    condition,   or    from    one-third  to 


Fig.  34. 


Fig.  35. 


Cervix  uteri  (at  about  the  sixth 
month  of  utero-gestation)  showing 
little  or  no  absorption. 


Cervix  uteri  (at  about  six  weeks 
later  than  Fig.  34)  showing  evident 
absorption. 


two-thirds  of  an  inch  within  a  few  hours  after  delivery, 
they  may  become,  through  contraction,  at  least  two  inches 
thick. 

The  changes  in  the  shape  of  the  uterus  presented  at 
different  periods  of  gestation  are  also  very  characteristic. 
From  being  flat  and  pyriform,  the  uterus,  after  impregna- 
tion, becomes  globular ;  the  cervix  also,  as  already  men- 
tioned, gradually  shortens  towards  the  end  of  the  fifth 
month,  losing  about  a  quarter  of  its  length  each  succeed- 


MKDICAL  JURISPRUDENCE   AND   TOXICOLOGY.      127 

ing  month,  until,  at  the  end  of  the  ninth  month,  it  has 
disappeared  entirely  (Figs.  34,  35,  36),  the  form  of  the 
uterus  being  then  ovoid.  After  delivery  at  full  term  the 
uterus  begius  usually  to  contract,  its  size  being  reduced 
within  two  days  to  six  inches  in  length  and  four  in  breadth. 

Fig.  36. 


Cervix  entirely  disappeared  and  expanded  over  uterine  contents. 

By  the  end  of  the  first  week  it  has  so  contracted  as  to 
measure  usually  from  5  to  6  inches  in  length.  At  the  end 
of  the  second  week  the  uterus  is  about  four  inches  long 
and  one  and  a  half  inches  broad.  By  the  end  of  the  sec- 
ond month  it  has  returned  to  its  normal  size.  In  those 
cases,  however,  in  which  death  occurring  at  full  term  is 
due  to  hemorrhage,  no  contraction  of  the  uterus  will  have 
taken  place.  If  the  woman,  however,  has  survived  for  a 
few  days,  the  uterus  will  be  found  more  or  less  contracted. 
During  pregnancy  the  round  ligaments  and  Fallopian  tubes 
increase  in  size  and  become  more  vascular ;  the  broad 
ligaments  are  gradually  effaced  through  the  great  develop- 
ment. 

Means  of  Producing  Foeticide. — Among  the  means 
first  tried  by  women  to  bring  on  a  miscarriage  may  be 
mentioned  the  effects  of  violence,  such  as  submitting 
to  a  severe  beating,  jumping  from  high  places,  as  tops 
of  fences,  gates,  etc.,  venesection,  emetics,  and  drastic  ca- 


128  A   MANUAL   OF 

thartics.1  As  a  general  rule,  however,  except  in  the  case 
of  very  feeble  or  weakly  women,  or  in  those  who  are  pre- 
disposed to  miscarriage,  such  measures  fail  to  produce  an 
abortion.  The  emmenagogues,  or  the  drugs  known  popu- 
larly as  abortives,  are  then  next  resorted  to,  on  account  of 
the  power  they  are  supposed  to  possess  of  inducing  uterine 
contractions  and  of  thus  causing  the  expulsion  of  the  foetus. 
Among  these  the  most  commonly  used  may  be  mentioned ' 
ergot  or  spurred  rye,  cotton-root,  savin,  or  the  tops  of  the 
juniperus  sabina,  tansy,  pennyroyal,  and  rue.  But  large 
doses  may  be  taken  of  these  drugs  without  causing  uterine 
contraction,  while  the  oils  of  savin  and  tansy  have 
frequently  caused  death,  through  gastritis  or  peritonitis 
being  produced  through  their  irritant  properties. 

All  such  means  having  failed  to  produce  an  abortion, 
instrumental  violence,  as  a  last  resource,  is  made  use  of  as 
the  only  certain  means  of  inducing  uterine  contractions 
and  of  so  insuring  the  expulsion  of  the  foetus.  The  rupture 
of  the  foetal  membranes,  however  skilfully  preformed,  is  a 
most  dangerous  operation,  always  liable  to  be  followed  by 
the  most  serious,  if  not  fatal,  consequences,  death  being 
frequently  caused,  as  already  mentioned,  by  either  hemor- 
rhage or  peritonitis.  When  the  operation  is  performed  by 
a  professional  abortionist,  long,  narrow,  sharp-pointed  in- 
struments are  made  use  of,  but  when  self-inflicted,  which 
is  not  unfrequently  the  case,  the  woman  uses  any  articles 
that  may  serve  her  purpose,  such  as  knitting-needles,  pen- 
holders, long  wires,  glove-stretchers,  etc. 

Abortion  from  Natural  Causes. — It  should  be  mentioned, 
in  connection  with  the  subject  of  foeticide,  that  abortion  very 
frequently  results  from  natural  causes.    Indeed,  with  some 

lrrardieu:    Etude  Medico-legale   sur  I' Avortement,  troisieme  edition^ 
Paris,  1868,  pp.  28,  99. 


MEDICAL  JUE1SPEUDENCE   AND   TOXICOLOGY.      12!) 

women  it  appears  to  be  habitual,  abortion  occurring  at  every 
pregnancy,  especially  in  theearly  months  of  gestation,  though 
every  effort  has  been  made  to  prevent  it.  As  might  be  ex- 
pected, the  tendency  to  abortion  is  most  marked  at  the  men- 
strual periods.  Predisposition  to  abortion  appears  to  be  due 
to  causes  which  affect  the  mother,  such  as  syphilis,  small- 
pox, albuminuria,  etc.,  or  those  which  affect  the  child,  as 
death  of  the  ovum,  disease  of  the  placenta.  Advantage 
is  no  doubt  often  taken  of  this  natural  tendency  to  abort  by 
producing  abortion  criminally.  As  natural  abortion  usually 
occurs  at  about  the  third  or  fourth  month  of  pregnancy, 
and  as  this  period  is  also  the  one  at  which  a  criminal 
operation  is  performed,  the  fact  that  the  foetus  comes  away 
entire  would  indicate  that  the  abortion  was  due  to  natural 
causes,  or  at  least  not  to  instrumental  violence.  If,  how- 
ever, the  foetus  be  expelled  first  and  the  ruptured  mem- 
branes afterwards,  the  conclusion  would  be  that  instruments 
had  been  used. 

Abortion  may  sometimes  be  feigned  by  women,  in  order 
to  extort  money  on  the  charge  of  seduction  and  consequent 
pregnancy.  The  examination  of  the  woman  will  usually 
be  sufficient,  under  such  circumstances,  to  disprove  the 
charge.  The  criminality  of  foeticide  is  not  excused  by  the 
fact  that  the  woman  was  not  pregnant,  or  by  the  fact  that 
the  pregnancy  was  extra-uterine.  Under  certain  circum- 
stances it  may  become  necessary  to  perform  an  abortion,  as 
in  cases,  for  example,  where  the  deformity  of  the  pelvis 
makes  the  delivery  of  a  living  child  at  full  term  a  physical 
impossibility.  In  all  such  cases  the  attending  physician 
should  insist  upon  a  consultation  being  held ;  and  the 
patient  and  her  family,  should  be  fully  informed  as  to  the 
nature  of  the  case  before  so  serious  an  operation  is  under- 
taken. 

9 


130  A    MANUAL   OF 


CHAPTER  XI. 

Infanticide — Live  Birth — Appearance  of  Infant  Born  at  Full  Term — 
Means  of  Determining  whether  Child  has  Breathed — Docimasia  Pul- 
monum — Objections  to  Hydrostatic  Test — Docimasia  Circulationis — 
Size  of  Liver  and  Contents  of  Stomach  in  New-born  Child— Exam- 
ination of  Mother — Signs  of  Recent  Delivery — Means  by  which 
Infanticide  is  Committed. 

By  infanticide  is  meant,  medico-legally,  the  murder 
of  the  new-born  child,  it  being  immaterial  whether  the 
child  is  murdered  immediately  or  a  few  days  after  its 
birth.  The  law  assumes,  until  it  is  proved  to  the  con- 
trary, that  every  child  is  born  dead,  on  account  of  the 
fact  that  so  many  children  are  brought  into  the  world  who 
are  either  dead  or  die  shortly  after  birth.  Inasmuch  as 
this  is  the  law,  the  prosecution,  and  not  the  defendant, 
must  prove  that  the  infant  alleged  to  have  been  murdered 
was  born  alive.  For  this  reason  great  difficulty  is  usually 
experienced  in  convicting  a  woman  charged  with  the  crime 
of  infanticide.  Apart  from  this  difficulty  she  is  often  de- 
livered in  the  absence  of  witnesses,  or  the  child  is  con- 
cealed or  destroyed.  The  jury  also  sympathizes  to  such  an 
extent  with  a  woman  accused  of  this  crime  that  conviction 
cannot  easily  be  secured.  Medico-legally,  to  be  born  alive 
implies  complete  expulsion  of  a  living  child  from  the 
mother.1  A  child,  for  example,  is  not  born  alive  if  any 
portion  of  it,  except  the  umbilical  cord,  is  retained  within 
the  vulva.  By  this  figment  of  the  law,  therefore,  the  de- 
struction of  a  living  child,  if  only  partly  born,  does  not 
constitute  murder. 

1  Guy  and  Ferrier:  op.  cit.,  p.  101;  Tidy:  op.  cit.,  part  ii.  p.  248; 
Taylor:  op.  cit.,  p.  592. 


MEDICAL  JURISPRUDENCE   AND   TOXICOLOGY.      131 

Appearance  of  an  Infant  Born  at  Full  Term. — In 
infanticide  the  child  is  generally  born  at  full  term.  But, 
inasmuch  as  children  are  frequently  brought  into  the 
world  at  an  earlier  period  of  gestation,  either  by  natural  or 
artificial  means,  it  is  important  for  the  medical  examiner, 
in  cases  of  infanticide  as  well  as  of  foeticide,  to  be  able  to 
state,  from  an  inspection  of  the  infant,  its  probable  age  at 
birth.  The  general  appearance  presented  by  an  infant 
born  alive  at  full  term  is  as  follows  :  Remains  of  the 
vernix  caseosa  or  sebaceous  matter  are  usually  found  be- 
hind the  ears  and  under  the  arm-pits ;  the  hair  is  dry  and 
clean  ;  the  eyes  are  half  open,  and  cannot  be  kept  closed ; 
the  ears  do  not  lie  close  to  the  head ;  the  caput  succedaneum, 
or  swelling  on  the  back  of  the  head,  is  well  marked ;  the 
thorax  is  distinctly  arched,  and  the  diaphragm  much  de- 
pressed. A  dead-born  child  is  usually  covered  with  the 
vernix  caseosa ;  the  hair  is  agglutinated ;  the  eyes  are 
closed ;  the  ears  lie  close  to  the  head  ;  the  thorax  is  flat- 
tened and  unexpanded  ;  the  lungs  lie  in  the  posterior  part 
of  the  thorax,  are  granular,  and  do  not  crepitate  upon 
pressure. 

In  case  of  the  death  of  the  foetus  some  time  before 
birth,  the  body  will  be  found  flaccid  and  flattened,  as  if 
it  had  been  macerated ;  the  cuticle  may  be  more  or  less 
detached,  especially  upon  the  abdomen ;  the  head  lies  flat, 
howsoever  it  may  be  placed,  the  cranial  bones  moving 
readily  upon  one  another;  the  cellular  tissue  is  infiltrated 
with  bloody  serum.  The  proofs  of  a  child  having  breathed, 
and  therefore  of  having  lived,  though  not  necessarilv  of 
having  been  born  alive  in  the  legal  sense,  are  derived  from 
the  condition  of  the  respiratory,  circulatory,  and  abdom- 
inal organs. 

3Ieans  of  Determining  whether  the  Child  has  Breathed. — 


132  A    MANUAL    OF 

Wliile  the  vaulted  character  of  the  thorax,  the  compara- 
tive depression  of  the  diaphragm,  the  relation  of  the  larynx 
to  the  epiglottis,  the  situation,  volume,  color,  consistence, 
absolute  or  relative  weight,  the  specific  gravity  of  the  lungs, 
may  all  be  important  under  certain  circumstances  in  en- 
abling the  examiner  to  determine  whether  an  infant  has 
breathed,  nevertheless  the  hydrostatic  test  is  the  only  one 
that  can  be  relied  upon,  and  even  that  with  certain  quali- 
fications, to  be  presently  mentioned.  The  principle  of  the 
hydrostatic  test,  or  the  docimasia  pulmonum,  is  based  upon 
the  fact  that  while  the  lungs  of  an  infant  that  have  been 
aerated  will  float  when  placed  in  water  on  account  of  the 
inspired  air,  those  of  an  infant  that  have  not  been  aerated 
will  sink.  To  apply  the  hydrostatic  test,  the  lungs  should 
be  removed  from  the  chest  of  the  infant  and  put  in  a  suf- 
ficiently capacious  vessel  containing  distilled  water  at  60° 
F.  If  the  lungs  float  upon  the  surface  of  the  water,  that 
will  prove  that  they  have  been  aerated.  It  is  desirable  also 
that  each  lung  should  be  divided  into  a  dozen  or  more  pieces, 
compressed,  and  then  tested  separately  in  the  same  manner. 
If  after  compression  all  the  pieces  float,  very  complete  aeration 
would  be  indicated.  It  must  be  admitted  that  the  hydro- 
static test,  while  it  serves  to  determine  whether  the  lungs 
of  the  infant  had  or  had  not  been  aerated,  does  not  neces- 
sarily prove  that  the  child  had  breathed,  still  less  had  been 
alive  in  a  medico-legal  sense,  although  it  may  establish  a 
strong  presumption  of  the  fact ;  since  the  head  of  the 
infant  may  be  retained  sufficiently  long  in  the  uterus  or 
the  vagina,  as  in  certain  elbow  or  breech  presentations, 
for  the  infant  to  breathe  though  subsequently  born  dead, 
and,  though  not  probable,  it  is  not  impossible  that  the 
air  found  in  the  lungs  of  the  infant  may  have  been 
artificially    introduced,    developed    through    putrefaction, 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      133 

or  be  emphysematous  in  nature.  Apart  from  the  diffi- 
culty of  artificially  inflating  the  lungs  of  an  infant  in 
situ  in  cases  of  infanticide,  nothing  of  that  kind  would 
be  attempted,  since  it  would  be  the  object  of  the  de- 
fendant to  prove  that  the  infant  had  been  born  dead,  and 
not  alive.  As  a  general  rule,  there  is  no  great  difficulty 
experienced  in  determining  whether  the  buoyancy  of  a  lung 
is  due  to  air  inspired  or  to  gases  developed  within  it 
through  putrefaction,  since  the  air  in  the  latter  case  is  not 
found  in  the  air-vesicles  of  the  lungs,  but  in  the  cellular 
tissue  and  in  the  form  of  large  bubbles,  which  disappear 
completely  under  pressure.  Moreover,  lungs  in  a  state  of 
putrefaction  differ  in  appearance  very  much  from  healthy 
lungs,  being  greenish-yellow  in  color,  having  but  little  con- 
sistence, and  emitting  a  fetid  odor.  It  may  be  mentioned, 
also,  in  this  connection,  that  as  the  lungs  of  the  infant  do 
not  putrefy  as  rapidly  as  the  other  organs,  if  these  organs  are 
found  undecomposed,  then  any  buoyancy  exhibited  by  the 
lungs  could  not  be  due  to  putrefaction.  As  it  is  very  doubtful 
whether  emphysema  is  ever  spontaneously  developed  in  the 
lungs  of  an  infant,  the  objection  that  the  air  in  the  lungs 
could  be  developed  in  this  way  is  without  foundation. 
On  the  other  hand,  it  may  be  objected  that  the  fact  that 
the  lungs  sink  when  immersed  in  water  does  not  necessarily 
prove  that  the  infant  had  not  breathed,  since  the  unaerated 
condition  of  the  lungs  might  be  due  to  disease.  AVhile  it 
is  true  that  the  density  of  the  lungs  will  be  so  much  in- 
creased by  pneumonia  or  congestion  that  they  will  sink  in 
water,  these  diseases  occur  so  rarely  in  new-born  children 
that  but  little  importance  need  be  attached  to  such  an  ob- 
jection. Notwithstanding  that  the  value  of  the  hydrostatic 
test  has  been  questioned,  that  it  cannot  be  expected  to  prove 
absolutely  that  the  child  has  breathed,  still  less  been  born 


134  A   MANUAL  OF 

alive,  medico-legally,  yet  if  the  lungs  of  an  infant  do  float 
in  water,  the  examiner  will  be  warranted,  under  ordinary 
circumstances,  in  stating  that  the  infant  had  breathed,  and 
in  all  probability  had  been  born  alive.  The  test  of  an 
infant  having  been  born  alive,  or  rather  of  having 
breathed,  based  upon  the  changes  undergone  by  the  heart 
and  certain  bloodvessels,  after  respiration  has  been  estab- 
lished, and  known  as  the  docimasia  circulationis,  is  of 
rather  limited  application,  as  will  become  apparent  when 
the  differences  between  the  foetal  and  adult  circulations 
are  considered. 

Foetal  Circulation. — The  principal  peculiarities  in  which 
the  circulation  of  the  foetus  differs  from  that  of  the  adult  are 
that  little  or  no  blood  flows  through  the  lungs  of  the  foetus, 
the  placenta  being  the  organ  by  means  of  which  the  blood  is 
aerated,  and  that  the  right  side  of  the  heart  communicates 
with  the  left,  the  blood  being,  therefore,  neither  arterial  nor 
venous,  as  in  the  adult,  but  mixed.  In  the  foetus  (PI.  3), 
part  of  the  blood  flows  directly  from  the  rightauricle  through 
the  foramen  ovale  into  the  left  auricle,  instead  of  indirectly 
by  the  right  ventricle,  pulmonary  artery,  lungs,  and  pul- 
monary veins ;  part  of  the  blood  from  the  right  ventricle 
through  the  pulmonary  artery  by  the  ductus  arteriosus 
into  the  aorta.  Further,  the  blood  flows  in  the  foetus  from 
the  placenta  by  the  umbilical  vein,  and  its  continuation 
the  ductus  venosus,  to  the  vena  cava  and  to  the  right 
side  of  the  heart,  and  thence  through  the  latter  as  just  de- 
scribed, little  or  none  going  to  the  lungs,  to  the  aorta,  and 
so  back  by  the  umbilical  arteries  to  the  placenta.  Such 
being  the  main  features  of  the  foetal  circulation,  with  the 
inspiration  of  air  and  the  separation  of  the  infant  from 
the  placenta  by  division  of  the  umbilical  cord  the  fora- 
men ovale  closes,  the  umbilical  vessels,  the  ductus  arte- 


p 


Left  auricle. 


Left  ventricle. 


Liver 


Portion  of 
small  intestine. 


[Kidney. 


Diagrammatic  View  of  Foetal  Circulation:  a,  arch  of  the  acta :  a',  its  dorsal  part: 
a",  lower  end  :  ws,  superior  vena  cava  :  vci,  inferior  vena  where  it  join?  the  right  auri- 
cle :  vci',  its  lower  end  ;  .".-,  subclavian  vessels:  .;',  right  jugular  vein":  <\  common  carotid 
arteries  :  tour  curved  dotted  arrow-lines  are  carried  through  the  aortic  and  pulmonary 
opening,  and  the  auriculo-ventricular  orifices  :  >la.  opposite  to  the  one  passing  through 
the  pulmonary  artery,  marks  the  place  of  the  ductus  arteriosus  :  a  similar  arrow-line 
is  shown  passing  from  the  vena  cava  inferior  through  the  fossa  oralis  of  the  risrht  auri- 
cle, and  the  foramen  ovale  into  the  left  auricle  :  hv,  the  hepatic  veins  :  vp.  vena  portse  : 
X  to  vci,  the  ductus  venosus  :  >n\  the  umbilical  vein :  ua,  umbilical  arteries  :  uc,  umbil- 
ical cord  cut  short :  i,  i ,  iliac  vessels. 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.      135 

riosus,  and  the  ductus  venosus  shrivel  up,  and,  ceasing  to 
be  pervious,  become  fibrous  cords.  The  blood  then  flows 
through  the  heart  and  lungs,  and  the  adult  circulation  is 
established. 

Under  ordinary  circumstances,  if  the  foramen  ovale, 
ductus  venosus,  and  ductus  arteriosus  are  found  open,  the 
examiner  would  be  warranted  in  stating  that  the  foetus 
had  not  been  born  alive,  and  that,  therefore,  in  all  prob- 
ability, if  any  crime  had  been  committed,  it  would  be  that 
of  foeticide,  and  not  of  infanticide.  Not  unfrequently,  how- 
ever, several  days  or  even  weeks  may  elapse  before  the 
blood  ceases  to  flow  through  these  vessels,  and  as  the  for- 
amen ovale  may  remain,  under  certain  circumstances,  open 
through  life,  obviously  too  much  importance  must  not  be 
attached  to  the  open  or  closed  condition  of  the  heart  and 
vessels  as  evidence  of  the  infant  having  been  born  dead 
or  alive.  The  drying-  up  of  the  part  of  the  umbilical 
cord  remaining  attached  to  the  umbilicus  after  division, 
that  usually  takes  place  within  two  or  three  days  after 
delivery,  together  with  its  subsequent  separation  and  cica- 
trization, may  be  regarded  as  proof  of  the  child  having 
been  born  alive,  since,  although  the  cord  withers  and 
dries  up  in  a  child  born  dead  as  well  as  in  one  born 
alive,  it  always  remains  attached  in  the  former  to  the 
umbilicus,  never  separating  spontaneously.  The  liver  of 
the  foetus  is  larger  than  that  of  a  recently  born  infant, 
and  that  of  the  infant  is  larger  than  that  of  an  eight  or 
ten  months  old  child. 

Liver  and  Contents  of  the  Stomach  in  a  New-born  Cliild. 
— Too  much  importance,  however,  must  not  be  attached 
to  the  size  of  the  liver  as  positive  proof  of  the  infant 
having  breathed,  since  the  difference  in  the  size  of  the 
liver  in  a  recently  born  child,  as  compared  with  its  size 


136  A   MANUAL  OF 

at  earlier  or  later  stages  of  development,  is  only  relative. 
The  presence  of  milk  or  of  farinaceous  and  saccharine 
articles  of  food  in  the  stomach  or  intestine  of  an  infant 
would  be  strong  evidence  that  it  had  lived  some  time  after 
birth.  Unfortunately,  the  remains  of  food  are  not  very 
frequently  found  in  the  alimentary  canal  of  infants  alleged 
to  have  been  destroyed.  In  certain  cases  of  infanticide  it 
may  become  of  importance  to  determine  the  age  of  the  new- 
born child  and  the  time  that  has  elapsed  since  its  death. 
Its  age  can  approximately  be  determined  by  ascertaining 
if  it  presents  all  the  characters  of  a  fully-matured  foetus 
that  have  already  been  described.  It  is  not  often  possible 
to  state  exactly  the  time  elapsing  between  the  birth  and 
death  of  an  infant,  as  so  many  conditions  have  to  be  taken 
into  consideration,  such  as  the  season  of  the  year,  the  tem- 
perature, the  character  of  the  place,  and  the  surroundings 
of  the  infant. 

Examination  of  the  Mother :  Signs  of  Recent  Delivery. — 
In  all  cases  of  infanticide  the  reputed  mother  should  be 
examined  as  well  as  the  infant.  The  examination  should 
be  made  as  soon  as  possible,  for,  if  delayed  beyond  a  week 
or  ten  days,  the  woman  may  have  so  recovered  as  to  pre- 
sent no  signs  of  having  been  recently  delivered.  Should 
the  examination  be  made  within  three  or  four  days  after 
delivery,  pallor  of  the  face  and  weakness  will  be  noticed ; 
the  skin  will  be  found  moist,  soft,  and  relaxed  ;  the  eyes 
somewhat  sunken.  The  pulse  is  soft  and  usually  quick. 
The  uterus  can  be  felt  through  the  wall  of  the  abdomen, 
which  feels  soft,  and  presents  transverse  livid  lines,  later 
becoming  white  and  shining,  and  known  as  the  linece  albi- 
cantes.  The  breasts  are  full  and  knotty,  and  often  exude 
a  watery  milk.  The  external  genitalia  are  swollen,  the 
vagina  is  capacious,  the   os  uteri  is  low  down,  and  the 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.       1 ->7 

niuco-sangumeous  discharge  from  the  uterus,  known  as 
the  lochia, and  characterized  by  its  peculiar  odor,  is  usually 
present.  No  one  of  these  signs  can  be  relied  upon  as 
proof  that  a  woman  has  recently  been  delivered  ;  but,  if 
they  all  be  present  together,  they  would  constitute  a  very 
strong  presumption  of  it.  Should  the  woman  have  died 
shortly  after  delivery,  not  only  would  the  signs  just  men- 
tioned be  present,  but  in  addition  the  uterus  would  be 
found  enlarged,  measuring  between  nine  and  ten  inches  in 
length  ;  its  cavity  lined  with  remains  of  the  decidua  and 
the  point  of  attachment  of  the  placenta  marked  by  a 
gangrenous-looking  spot.  In  all  cases  of  infanticide,  the 
mother  not  only  endeavors  to  conceal  the  fact  that  she  has 
given  birth  to  a  child,  but  more  especially  to  conceal  the 
body  of  the  child.  The  concealment  of  pregnancy  is  not 
an  offence  in  the  eye  of  the  law ;  but  the  concealment  of  a 
birth,  constituting  a  misdemeanor,  renders  the  woman 
committing  it  liable  to  punishment.1  As  the  woman,  how- 
ever, who  is  convicted  upon  this  charge  is  punished  upon 
the  ground  of  having  concealed  the  body  of  the  dead  in- 
fant rather  than  upon  that  of  having  concealed  its  de- 
livery, she  makes  every  effort  to  get  rid  of  the  child. 

Means  of  Committing  Infanticide. — Among  the  different 
means  made  use  of  to  destroy  the  new-born  child  may 
be  mentioned  suffocation,  immersion  in  privies,  strangula- 
tion, drowning,  fracturing  of  the  skull,  burning,  neglect, 
wounds,  hemorrhage  of  the  navel,  exposure  to  cold,  and 
poisoning.  In  fully  four-fifths  of  cases  of  infanticide 
death  is  due  to  asphyxia  in  one  form  or  another.  Statis- 
tics show  that  fifty  per  cent,  of  infants  criminally  de- 
stroyed are  suffocated,  twelve  per  cent,  immersed  in 
privies,    ten    per    cent,    strangled,    and    live    per    ceut. 

1  Tardieu  :  Etude  Medico-legale  sur  P Infanticide,  Paris,  186S,  p.  99. 


138  A    MANUAL   OP 

drowned.  Infants  are  not  unfrequently  also  destroyed 
by  fractures  of  the  skull  and  by  neglect.  Death  caused 
by  burns,  wounds,  hemorrhage  of  the  navel,  and  exposure 
to  cold  occurs  less  often,  however,  in  cases  of  infanticide, 
and  in  frequency  in  about  the  order  mentioned. 


MEDICAL    JURISPRUDENCE    AND    TOXICOLOGY.       139 


CHAPTER   XII. 

Legitimacy — Inheritance — Protracted  Gestation — Premature  Delivery 
— Viability — Procreative  Power  in  the  Male  and  Female — Impotence 
— Sterility — Tenancy  by  Courtesy — Paternity — Affiliation  —  Super- 
fee  tat  ion —  Doubtful  Sex — Hermaphrodism — Presumption  of  Death — 
Presumption  of  Survivorship — Personal  Identity  of  the  Living. 

Cases  involving  the  questions  of  legitimacy  and  inherit- 
ance are  not  often  decided  by  the  testimony  of  the  medical 
expert  alone,  the  evidence  necessary  to  prove  that  a  child 
is  the  offspring  of  adultery  being  of  another  character.  In 
all  such  cases,  however,  questions  arise  relating  to  the 
length  of  time  in  which  gestation  may  be  prolonged  or 
shortened. 

Protracted  Gestation. — The  subjects  of  protracted  gesta- 
tion and  premature  delivery  having  already  been  consid- 
ered in  connection  with  the  signs  of  pregnancy,  it  only 
remains  to  point  out  their  bearing  in  relation  to  cases  of 
legitimacy  and  inheritance.  The  law  assumes  that  even- 
child  born  in  wedlock  is  legitimate  unless  it  can  be  shown 
that  the  husband  and  wife  had  been  separated  for  a  longer 
time  than  that  accepted  as  the  average  period  of  gesta- 
tion, or  that  the  husband  was  impotent.  The  difficulty, 
however,  that  would  at  once  present  itself  in  such  a  case 
is  due  to  the  impossibility  of  stating  exactly  what  consti- 
tutes the  accepted  period  of  gestation.  It  is  true  that  the 
average  period  of  gestation  is  280  days  ;  nevertheless,  there 
are  authenticated  cases,  as  already  mentioned,  in  which 
gestation  was  prolonged  to  313  or  even  to  325  days,  or 
delivery  was  premature,  as  at  210  to  217  days. 

But  it  must  be  admitted  that  the  strongest  possible  evi- 
dence would  be  required  to  prove  the  legitimacy  of  a  child 


140  A    MANUAL   OF 

whose  birth  was  shown  not  to  have  occurred  until  313 
days  after  the  absence  or  death  of  the  husband. 

Premature  Delivery. — As  regards  the  relation  of  pre- 
mature birth  to  questions  of  legitimacy  and  inheritance, 
there  is  no  doubt  that  eight,  seven,  and  even  six  months' 
infants  may  survive.1  It  has  been  stated  that  in  very 
exceptional  instances  even  a  foetus  but  little  over  five 
months  old  may  be  viable.  In  cases,  for  example,  where 
a  living  infant  acquires  the  right  of  inheriting  and 
transmitting  property,  the  point  that  will  have  to  be 
established  is  not  whether  the  infant  was  viable  in  the 
sense  that  it  would  survive,  but  was  it  alive  at  the  time 
of  its  birth,  involving  in  turn  the  determination  of  what 
is  meant  by  the  expression  being  born  alive.  In  a  broad 
sense  the  foetus  must  be  regarded  as  alive  at  any  stage  of 
its  development ;  the  ovum,  indeed,  must  be  alive,  since 
the  embryo  or  foetus  results  from  the  development  of  a 
live  ovum,  not  a  dead  one,  impregnated  by  living  sperma- 
tozoa. Leaving  out  of  consideration,  however,  what  might 
be  regarded  as  merely  metaphysical  distinctions,  as  a  mat- 
ter of  fact  that  which  constitutes  a  live  birth  will  depend 
upon  the  significance  attached  to  that  expression  by  the 
law  of  the  land,  whatever  that  may  be.  In  the  United 
States  and  in  England  neither  breathing  nor  crying  is 
considered  essential  to  establish  the  fact  that  a  child  was 
born  alive.  It  is  enough  if  the  whole  body  has  been 
brought  into  the  world  and  the  heart  has  throbbed,  or 
if  a  movement  of  any  kind  has  been  made.  In  Scot- 
land and  Germany  crying,  and  in  France  respiration, 
is  requisite.  That  crying  should  not  be  regarded  as 
indispensable   in  proving  a  live  birth   is  obvious,  since 

1  According  to  Haller  (Elementa  Pkysiologice,  tomus  octavus,  Lausanne, 
1778,  p.  423) :  "Ante  septimum  mensem  foetus  non  potest  superesse." 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.      141 

a  child  might  be  born  alive,  and  yet  peradventure  it 
might  be  born  dumb.1  Tlie  term  bom  alive  or  viable 
being  so  understood,  medico-legally,  it  might  be  stated 
with  perfect  propriety  that  a  foetus  but  six  inches  long, 
weighing  only  eight  ounces,  not  more  than  four  months 
old,  was  born  alive,  was  viable — having  moved  its  arms 
and  legs,  opened  its  mouth,  etc. — though  it  died  within 
half  an  hour  of  its  birth.2  The  law  assumes  that  a  child 
born  in  wedlock  is  legitimate  unless  it  can  be  proved  that 
the  husband  was  impotent — by  which  it  is  meant  that  he 
was  physically  incapable  at  the  alleged  period  of  concep- 
tion of  begetting  children. 

Impotence  may  be  due  to  masturbation,  to  the  opium 
and  the  alcoholic  habit,  diseases  of  the  nervous  system, 
blows  upon  the  head  and  back,  absence,  deficiency,  or 
malformation  of  the  penis,  as  hypospadias,  epispadias, 
fistula  in  perineo,  castration,  cancer  or  absence  of  the 
testicles,  absence  of  spermatozoa  from  the  semen,  etc. 

In  connection  with  the  absence  of  the  testicles  it  should 
be  mentioned  that  their  mere  absence  from  the  scrotum 
does  not  involve  impotence,  since  such  a  condition  may  be 
simply  due,  as  in  cry psorch ides,  to  the  testicles  not  having 
descended  into  the  scrotum  from  the  inguinal  canal.  Of 
the  conditions  causing  impotence  some  are  susceptible  of 
treatment ;  others  are  not.  The  procreative  power  in  the 
male,  or  the  age  of  puberty,  begins  at  between  fourteen  to 
fifteen  years  of  age,  with  the  full  development  of  the 
testicles,  the  power  of  fecundation  depending  upon  the 
presence  of  active  spermatozoa  in  the  semen.  The  pro- 
creative  power  may  continue  to  an  advanced  period  of  life, 
spermatozoa  being   found,  as  already   mentioned,   in   the 

1  Coke:  Institutes,  Philadelphia,  1S53,  vol.  i.  29b.  ma. 

2  British  and  Foreign  Medical  Review,  vol.  vi.  p.  236. 


142  A   MANUAL   OF 

semen  of  very  old  men.  The  impotence  of  old  men  ap- 
pears to  be  due  to  the  sluggishness  of  their  spermatozoa 
rather  than  to  their  absence  from  the  semen.  It  should 
be  mentioned  that  there  may  be  impotency  without  ster- 
ility, as  in  those  cases  in  which  sexual  intercourse  is 
prevented  by  malformation  of  the  penis;  and,  on  the  other 
hand,  sterility  without  impotency,  as  in  cases  of  castration. 

The  procreative  power  begins  in  the  female,  as  well 
known,  earlier  than  in  the  male,  at  about  from  twelve  to 
thirteen  years  of  age,  and  even  earlier  in  tropical  countries. 
In  the  female,  as  in  the  male,  unfruitfulness  may  exist 
without  incapacity  for  sexual  intercourse,  and  vice  versa. 
Sterility  in  the  female  may  be  due  to  debility,  leucorrhoea, 
dysmenorrhoea,  amenorrhoea,  menorrhagia,  absence  or  dis- 
ease of  the  uterus  or  ovaries,  imperforate  vagina  or  hymen, 
occlusion  of  the  uterus,  etc.  It  is  an  interesting  fact  that 
while  a  woman  may  be  sterile  with  one  man  she  may  be 
fertile  with  another,  it  frequently  happening  that  a  woman, 
married  for  years  without  issue,  in  contracting  a  second 
marriage  may  bear  children.  As  the  law  regards  a  child 
as  legitimate,  though  not  conceived  in  wedlock,  the  mother 
marrying  afterwards,  and  her  condition  being  recognized 
by  the  husband  at  the  time  of  the  marriage,  and  as  a  child 
born  after  the  death  of  its  mother  is  legitimate,  though 
the  marriage-tie  be  dissolved  by  the  death  of  the  mother, 
it  follows  that  a  child,  though  conceived  before  marriage 
and  born  after  the  death  of  the  mother — that  is,  neither 
conceived  nor  born  in  wedlock — would  nevertheless  be 
legally  regarded  as  legitmate. 

Grounds  for  Divorce. — Impotence  or  sterility  may  con- 
stitute grounds  for  divorce  proceedings  on  the  part  of  hus- 
band or  wife,  provided  it  can  be  proved  that  the  incapacity 
for  sexual  intercourse  existed  at  or  before  the  time  of 


MEDICAL  JURISPRUDENCE   AND  TOXICOLOGY.      1  \'-> 

marriage.  If  such  incapacity  supervened,  however,  after 
marriage,  as  due  to  disease,  there  would  be  no  grounds 
for  such  proceedings.  Tn  such  cases  a  medical  examina- 
tion would,  of  course,  be  necessary,  and  while  such  an 
examination  could  not  be  made  compulsory,  any  refusal 
on  the  part  of  either  of  the  contending  parties  to  submit 
to  the  same  would  certainly  be  injurious  to  the  cause  of 
the  party  so  refusing. 

So-called  "  frigidity  of  constitution,"  or  unwillingness  to 
submit  to  sexual  intercourse,  would  not  constitute  grounds 
for  legal  divorce,  absolute  proof  being  required  of  incapacity 
for  sexual  intercourse  or  of  severe  and  intense  pain  being 
suffered  by  indulging  in  it,  as  in  cases  of  vaginismus,  etc. 

Tenancy  by  Courtesy. — In  cases  where  a  husband  acquires 
a  life-interest  in  the  estate  of  his  wife,  a  child  having  been 
born  during  the  life  of  the  latter,  "  tenancy  by  courtesy  " 
as  it  is  called,  the  medical  examiner  may  be  called  upon  to 
prove  not  only  that  the  child  was  born  alive,  but  also  that 
it  was  born  while  its  mother  was  living,  in  order  that 
the  child  may  inherit.  The  proofs  of  a  live  birth  have 
already  been  considered. 

With  reference  to  the  legal  qualification  of  a  child 
having  been  born  during  its  mother's  lifetime  the  only 
difficulty  that  might  present  itself  would  be  in  the  case  of 
a  child  removed  from  its  dead  mother  by  the  Cesarean 
section,  in  which  instance,  if  the  letter  of  the  law  was  car- 
ried out,  the  husband  would  be  debarred  from  inheriting. 
The  interpretation  of  the  clause  providing  that  the  child 
must  be  capable  of  inheriting  will  depend  upon  what  the 
law  chooses  to  regard  as  a  monster — the  latter  not  being 
capable  of  either  inheriting  or  transmitting  property.  It 
is  very  difficult,  however,  to  say  what  constitutes  a 
monster  legally.     If  a  monster  be  defined  as  a  creature 


144  A    MANUAL   OF 

which  has  not  the  shape  of  mankind,1  then  a  headless 
or  double-headed  or  double-bodied  creature  would  be 
excluded  from  inheriting.  On  the  other  hand,  difficulty 
will  be  equally  experienced  in  disposing  of  a  property 
if  a  creature  with  two  heads,  with  or  without  two  bodies, 
be  regarded  as  two  individuals,  and  every  creature  with 
a  single  head,  whether  disomatous  or  not,  as  only  one 
individual.2 

Paternity  and  Affiliation. — In  connection  with  the  sub- 
jects of  legitimacy  and  inheritance,  that  of  paternity  and 
affiliation  may  as  appropriately  be  considered  here  as  else- 
where. The  question  of  paternity  presents  itself  under 
various  circumstances,  as,  for  example,  in  cases  of  bastardy, 
where  the  alleged  father  is  compelled  to  support  the  child, 
or  where  a  bastard  child  claims  to  be  the  heir  of  an  estate, 
or  where  a  child  is  born  ten  months  after  a  second  marriage, 
the  woman  having  married  a  second  time  within  a  month  of 
the  death  of  her  first  husband.  In  such  cases  the  paternity 
is  determined  by  the  likeness  of  the  child  to  the  parent,  the 
color,  features,  attitude,  habits,  gestures,  voice,  personal  de- 
formities being  taken  into  consideration.  In  certain  cases, 
questions  of  affiliation  arise,  as  in  the  case  of  a  woman 
having  had  intercourse  with  two  men  within  a  few  days 
of  each  other  and  giving  birth  to  a  child,  one  of  the  men 
being  affiliated  as  the  father  rather  than  the  other.  In 
connection  with  such  cases,  the  medical  examiner  should 
bear  in  mind  that,  in  the  lower  animals  at  least,  the  im- 
press of  the  first  sire  may  be  often  seen  in  the  foal  begotten 
by  the  second  one.     In  cases  involving  the  capability  of 

^lackstone:  Commentaries  on  the  Laws  of  England,  Philadelphia, 
1877,  Book  II.  p.  246. 

2  St.  Hilaire:  Histoire  general  et  particulaire  des  Anomalies  de  I' Organi- 
sation chez  l' Homme,  Bruxelles,  1837,  tome  iii.  p.  331, 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      145 

inheriting  and  transmitting  property,  the'  question  of 
superfcetation,  or  the  possibility  of  a  woman  conceiving  a 
second  time  when  already  pregnant,  may  present  itself. 

Superfcetation. — In  cases  of  superfcetation  either  two  chil- 
dren are  born  at  the  same  time,  one  of  which,  however,  is 
immature,  or  two  children  are  born  at  different  times,  both 
of  which  are  mature  cases  of  superfcetation  of  the  first  kind. 
Superfcetation  may  be  explained  on  the  supposition  that  there 
has  been  a  twin  conception,  one  of  the  embryos,  however, 
developing  more  rapidly  than  the  other ;  or  that  the  uterus 
was  double,  as  is  always  the  case  in  the  marsupial  animals, 
like  the  kangaroos,  etc.  Cases  of  the  second  kind  can, 
however,  only  be  explained  by  supposing  that  the  woman 
had  sexual  intercourse  with  one  or  two  different  men  and 
conceived  successively.  That  superfcetation  may  be  due 
to  repeated  sexual  intercourse  and  to  successive  conceptions 
there  can  be  no  doubt;  there  are  well-authenticated  cases 
of  a  woman  having  given  birth  to  children  of  different  colors 
as  the  result  of  intercourse  with  a  white  and  a  black  man 
successively.  It  is  also  well  known  that  double  concep- 
tion occurs  in  animals — a  mare,  for  example,  covered 
successively  by  a  horse  aud  an  uss,  giving  birth  to  a  horse 
and  a  mule. 

Double  Sex :  Hermaphroditism. — Not  infrequently,  on  ac- 
count of  divorce  proceedings,  questions  in  regard  to  legiti- 
macy of  offspring  or  capability  of  inheriting,  etc.,  the  atten- 
tion of  the  medical  examiner  is  called  to  individuals  in  whom 
the  sex  is  doubtful,  or  who  are  said  to  be  hermaphrodites. 
While,  as  a  general  rule,  there  is  no  difficulty  in  distinguish- 
ing the  sex  in  such  cases,  nevertheless,  on  account  of  the 
manner  in  which  external  and  internal  generative  organs 
develop  in  certain  exceptional  cases,  it  becomes  very  difficult, 
if  not  impossible,  at  least  during  life,  to  state  positively 
10 


146  A    MANUAL   OF 

whether  an  individual  is  a  male  or  a  female.  At  an  early 
period  of  intra-uterine  life,  at  six  weeks  or  thereabouts,  it 
is  impossible  to  determine  the  sex  of  the  embryo.  The 
external  organs  of  generation  are  as  yet  undeveloped,  and 

Fig.  37. 


Diagram  of  the  Wolffian  bodies,  Mullerian  ducts,  and  adjacent  parts  previous 
to  sexual  distinction  (as  seen  from  before) :  sr,  the  suprarenal  bodies ;  r,  the 
kidneys ;  ot,  common  blastema  of  ovaries  or  testicles ;  W,  Wolffian  bodies ; 
w,  Wolffian  ducts ;  m  m,  Mullerian  ducts  ;  gc,  genital  cord  ;  ug,  sinus  urogeni- 
tals ;  i,  intestines  ;  cl,  cloaca  (Quain). 

the  internal  organs  consist  (Fig.  37)  of  what  may  be 
called  two  indifferent  bodies,  the  ducts  of  Muller  and  the 
Wolffian  bodies.  In  case  of  such  an  embryo  developing 
into  a  male,  the  two  indiffereut  bodies  will  become  testicles, 
which,  in  descending,  push  the  abdominal  walls  ahead  of 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOOY.      147 

them,  giving  rise  in  this  way  to  the  formation  of  the 
scrotum,  which  they  ultimately  occupy.  The  Wolffian 
bodies  are  transformed  into  the  epididymis,  vas  deferens, 
etc.,  the  ducts  of  Miiller  becoming  atrophied. 

On  the  other  hand,  should  such  an  embryo  develop  into 
u  female,  the  two  indifferent  bodies  would  become  ovaries 
and  remain  in  the  abdominal  cavity,  and  the  ducts  of 
Miiller  would  be  transformed  into  the  vagina,  uterus,  and 
Fallopian  tubes,  the  Wolffian  bodies  becoming  atrophied. 
The  penis  and  clitoris,  developing  later  than  the  internal 
generative  organs,  consist  essentially  of  the  same  parts, 
the  only  difference  between  them  being  due  to  the  fact  that 
the  two  folds  of  skin  which  remain  distinct,  as  the  labia 
minora  in  the  female,  grow  around  and  underneath,  as  the 
skin  of  the  penis  in  the  male ;  while  the  two  cutaneous 
folds  constituting  the  labia  majora  of  the  female,  in  fusing 
together  in  the  middle  line,  form  the  scrotum  in  the  male. 

Such  being  the  development  of  the  generative  organs,  it 
is  readily  seen,  on  the  supposition  that  an  individual  is 
really  a  male,  that,  if  the  testicles  in  such  a  case  were  to 
remain  in  the  abdominal  cavity,  the  labia  majora  and 
minora  failing  at  the  same  time  to  coalesce  in  the  middle 
line,  and  the  penis  to  remain  undeveloped,  such  an  indi- 
vidual might  be  easily  mistaken  for  a  female.  On  the 
other  hand,  if  the  clitoris,  a  highly  erectile  organ,  was 
very  much  developed,  and  permitted  sexual  intercourse, 
such  an  individual  might  be  considered  a  male,  it  being 
supposed  that  the  testicles  had  not  descended  ;  the  absence 
of  a  scrotum  being  in  that  way  explained.1 

It  is  obvious,  from  what  has  been   said,  that  a  true 
human  hermaphrodite,  that  is  a  human  creature  in  which 
a  full  functionally  complete  set  of  organs  are  united  in  one 
1  Beck  :  op.  cit.,  vol.  i.  pp.  169,  170,  172,  175. 


148  A    MANUAL   OF 

individual,  is  a  physical  impossibility.  For,  even  on  the 
supposition  that  the  Mullerian  ducts  and  Wolffian  bodies 
would  be  simultaneously  transformed  into  vagina,  uterus, 
epididymis,  vasa  deferentia,  etc.,  one  of  the  indifferent 
bodies  into  an  ovary,  the  other  into  a  testicle,  a  penis  would 
not  be  developed  simultaneously  with  a  clitoris,  since  being 
essentially  one  and  the  same  structure  one  or  the  other  is 
alone  developed.  That  the  clitoris  and  the  penis  are 
essentially  homologous  organs  is  still  further  proved  by 
the  fact  that  urination  is  accomplished  by  the  clitoris  in 
the  female  of  certain  animals,  rodents,  and  others  exactly 
as  by  the  penis  in  the  male  of  the  same  species.  It  need 
hardly  be  added  that,  while  there  is  no  authenticated  case 
proving  that  a  true  human  hermaphrodite  has  ever  existed, 
such  a  disposition  of  the  generative  apparatus  not  unfre- 
quently  occurs  among  the  lower  animals,  as  snails,  tape- 
worms, etc. 

In  cases  where  an  estate  descends  to  the  first-born  male, 
if  the  offspring  should  be  of  doubtful  sex,  the  peculiarities 
constituting  the  individual  a  male  would  have  to  be  de- 
termined by  the  medical  expert.  In  such  doubtful  cases 
the  decision  might  be  postponed  until  the  child  arrives  at 
the  age  of  puberty,  when  the  secretion  of  healthy  active 
spermatozoa  would  establish  the  sex.  It  is  important,  with 
reference  to  the  attaining  of  majority,  that  the  exact  day 
and  hour  of  a  child's  birth  be  accurately  noted — a  person 
attaining  a  legal  majority  the  first  instant  of  the  day  before 
the  twenty-first  anniversary  of  his  or  her  birth-day,  though 
forty-seven  hours  and  fifty-nine  minutes  less  than  the  com- 
plete number  of  days,  counting  by  hours  on  the  principle 
that  a  part  of  a  day  is  medico-legal ly  equal  to  the  whole 
of  a  day.1 

1  Taylor :  op.  cit.,  p.  599. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      149 

Presumption  of  Death. — It  not  uii frequently  happens 
that  a  person  leaves  his  home  and  is  not  heard  of  for 
many  continuous  years,  perhaps  never  again.  The  law 
presuming  such  a  person  to  be  dead,  the  executor  is 
justified  in  settling  the  estate.  The  length  of  time 
usually  assumed  legally  as  warranting  the  presumption 
of  death  is  seven  years  from  the  time  the  person  was 
last  seen  or  heard  of.1  A  woman  who  had  not  heard 
of  her  husband  for  that  number  of  years  might  marry 
again,  therefore,  without  rendering  herself  liable  to  the 
charge  of  bigamy,  even  if  it  was  afterwards  shown  that 
the  first  husband  was  living  at  the  time  of  the  second  mar- 
riage. In  cases  where  property  is  inherited,  and  in  life- 
insurance  cases,  so  long  a  time  as  seven  years  is  not  usually 
considered  necessary  by  the  courts,  settlements  being  often 
made  in  two  years  of  the  period  within  which  the  person 
was  presumed  to  have  died.  The  presumption  of  death  is 
usually  determined  by  a  jury  on  the  general  evidence 
submitted. 

Under  certain  circumstances,  however,  as  in  cases  where 
the  person  presumed  to  be  dead  was  suffering  from  some 
disease  at  the  time  last  seen  or  heard  of,  medical  testimony 
would  be  taken  as  to  the  probable  issue  in  such  a  case. 

Presumption  of  Survivorship. — When  several  persons, 
members  of  the  same  family,  for  example,  are  lost  at 
sea  or  are  burned  in  a  fire,  the  law  usually  assumes  that 
they  perished  together.  But,  in  the  disposition  of  an 
estate  thus  left,  it  may  be  a  matter  of  difficulty  to  de- 
termine who  is  the  heir-at-law,  and  medical  testimony 
may  be  taken  to  aid  in  determining  what  member  of 
the  family,  if  any,  survived  the  others.  Suppose  that  the 
persons  dying  were  father  and  son,  and  that  the  son 
1  Beck :  op.  cit.,  vol.  i.  p.  643 ;  Tidy :  op  cit.,  part  i.  p.  385. 


150  A   MANUAL  OF 

survived  the  father,  even  though  it  were  for  a  moment,  the 
wife  would  inherit.  Suppose  that  two  persons  were  related 
to  each  other  as  testator  and  legatee,  and  that  the  latter 
should  die  first,  the  legacy  would  then  lapse.  If,  however, 
the  legatee  survived  the  testator,  then  his  heirs  would  in- 
herit. A  husband,  as  already  mentioned,  inherits  from  his 
wife  if  their  child  survives  the  death  of  the  mother,  even 
for  only  a  moment. 

While  no  positive  statements  can  be  made  by  the  medi- 
cal examiner  in  cases  involving  the  presumption  of  sur- 
vivorship, there  are,  nevertheless,  certain  general  probabili- 
ties that  should  be  taken  into  consideration.  Thus,  for 
example,  if  a  number  of  persons  of  different  ages  perish 
together,  it  would  be  a  fair  presumption  that  the  very  old 
and  very  young,  other  things  being  equal,  would  not  sur- 
vive as  long  as  those  of  middle  age.  In  the  case  of  a  man 
and  woman  being  drowned,  it  is  to  be  presumed  that,  on 
account  of  greater  physical  strength,  the  man  survived 
longer  than  the  woman.  Young  people  and  old  persons 
appear  to  succumb  more  quickly  to  the  effects  of  cold  than 
adults.  The  latter,  however,  do  not  resist  the  effects  of 
heat  as  well  as  the  former.  As  regards  the  effects  of  cold 
and  heat  upon  the  human  system,  more  particularly  in 
reference  to  questions  of  survivorship,  the  general  physical 
condition,  the  kind  of  clothing,  the  extent  to  which  alcohol 
has  been  indulged  in,  would  have  to  be  taken  into  consid- 
eration. It  is  well  known  that  the  aged  can  do  without 
food  better  than  the  young.  In  cases  of  death  from  star- 
vation, the  presumption  would  be,  therefore,  in  favor  of 
the  former  surviving  rather  than  the  latter. 

Personal  Identity  of  the  Living. — In  cases  involving 
the  inheritance  of  property,  medical  testimony  is  occa- 
sionally taken  in  identifying  a  certain  individual  as  the 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.       151 

rightful  heir — the  evidence  upon  which  the  identification 
depends  being  the  presence  of  scars,  deformities  due  to 
fractures,  etc.  Similarly,  in  cases  of  assault  or  of  robbery, 
the  assailant  must  be  identified.  As  the  identity  of  a  per- 
son, whatever  the  nature  of  the  case,  civil  or  criminal,  is 
usually  established  by  the  members  of  the  family,  friends 
or  acquaintances,  and  not  by  a  physician,  it  is  unnecessary 
to  dwell  upon  the  subject  of  the  personal  identity  of  the 
living. 

In  this  connection  it  may  be  stated,  however,  that  among 
the  more  important  means  of  identification  may  be  men- 
tioned the  size  of  the  person,  the  dress,  kind  of  voice,  the 
presence  of  moles,  scars,  deformities,  cicatrices,  naevi,  tattoo 
marks,  etc.1  In  relation  to  the  subject  of  personal  identity, 
a  few  words  with  reference  to  the  distance  at  which  per- 
sons can  be  seen  and  sounds  heard  do  not  appear  inappro- 
priate. A  man  of  ordinary  height  may  be  seen  on  a  clear 
day  and  on  level  ground  at  a  distance  of  from  two  to  three 
miles,  though  not  necessarily  recognized.  The  recognition 
of  a  person  depends  not  only  upon  being  seen,  but  upon 
the  appreciation  of  the  peculiarities  afforded  by  his  size, 
gait,  complexion,  color  of  hair  and  eyes,  etc.  Even  the 
best  known  persons  are  not  always  recognized  at  a  distance 
of  one  hundred  and  nine  yards;  less  well-known  ones  not 
being  recognized  even  though  but  thirty  yards  away.  Well- 
known  persons  cannot  be  recognized  in  the  clearest  moonlight 
twenty  yards  away,  and  by  starlight  at  a  distance  exceed- 
ing twelve  feet,  though  the  light  from  a  flash  of  light- 
ning or  from  a  pistol-shot  may  enable  a  person  to  recognize 
another  as  a  thief  or  an  assailant.  The  distance  at  which 
sounds  cau  be  heard,  such  as  the  report  of  a  gun  or  a  pis- 
tol, being  dependent  upon  the  condition  of  the  atmosphere, 
1  Woodman  and  Tidy:  op.  cit.,  pp.  C39-641. 


152  A   MANUAL   OF 

moisture,  direction  of  the  wind,  is  too  variable  to  be  posi- 
tively stated.  As  well  known,  however,  the  velocity  of 
sound  being  at  mean  temperature  about  1130  feet  in  a 
second,  if  a  flash  of  light  is  seen  and  a  report  is  heard 
afterwards,  on  the  supposition  that  they  were  simultane- 
ously produced,  the  distance  separating  the  person  who 
fired  and  the  one  hearing  the  report  can  be  calculated. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.       1  -h\ 


CHAPTER    XIII. 

Feigned  Bodily  Diseases — Hypnotism — Life  Insurance — Medical  Mal- 
practice— Medical  Registration. 

Feigned  bodily  diseases  very  frequently  demand  the 
attention  of  the  medical  examiner,  especially  in  the 
cases  of  soldiers,  sailors,  and  prisoners,  who  resort  to  any 
and  every  pretext  to  shirk  their  duties ;  and  of  civilians, 
who  hope  in  this  way  to  avoid  serving  on  juries,  appearing 
as  witnesses,  or  to  escape  military  service.  It  is  almost 
incredible  what  malingerers  will  resort  to  in  order  to  ac- 
complish their  purpose,  indulging  in  the  most  disgusting 
performances  :  swallowing  feces,  urine,  blood,  mutilating 
themselves  as  occasion  may  require.  Disease  is  sometimes 
simulated  by  simply  lying,  or  by  mimicry,  or  cunning ; 
at  other  times  by  the  aid  of  trusses,  splints,  bandages, 
spectacles,  crutches,  and  such  means.  The  motives  in- 
ducing a  person  to  simulate  disease  are  usually  fear,  gain, 
laziness,  notoriety.  Thus,  for  example,  it  is  not  unusual, 
especially  abroad,  where  military  service  is  compulsory, 
for  such  as  are  liable  to  cut  off  a  finger,  break  a  tooth,  or 
put  out  an  eye,  to  avoid  conscription.  The  hope  of  gain 
is  a  very  common  motive,  as  in  the  attempts  so  often 
made  to  obtain  damages  for  injuries  incurred  in  railroad 
accidents.  Beggars  and  others,  to  escape  work  and  to  get 
into  hospitals  or  almshouses,  often  feign  disease. 

Hysterical  persons,  especially  women,  will  stoop  to  every 
kind  of  deceit,  and  submit  even  to  harsh  treatment,  through 
a  pure  love  of  notoriety.  While  there  is  no  kind  of  dis- 
ease or  injury  which  malingerers  will  not  simulate  in  order 


154  A   MANUAL   OF 

to  accomplish  their  purpose,  whatever  that  may  be,  among 
the  most  common  of  these  may  be  mentioned  the  feigning 
of  fever,  heart  disease,  consumption,  hsematuria,  inconti- 
nence of  urine,  epilepsy,  paralysis,  catalepsy,  deafness, 
dumbness,  blindness,  tumors,  wounds,  etc.1  All  such  cases 
of  malingering  demand  the  greatest  patience  and  tact  on 
the  part  of  the  medical  examiner.  Not  only  one  but 
several  visits  may  be  required  before  the  examiner  can  be 
satisfied  that  the  case  is  one  of  malingering.  The  visits 
should  be  paid  at  an  hour  when  the  suspected  person  is 
least  likely  to  expect  them.  The  parts  of  the  body  said  to 
be  diseased  or  injured  should  be  examined  unclothed, 
thoroughly  exposed,  all  dressings  and  bandages  being  re- 
moved. No  attention  or  importance  should  be  attached 
to  the  statements  of  either  the  person  supposed  to  be  ma- 
lingering, or  of  his  relatives  or  friends.  The  prescribing 
of  some  disagreeable  medicine,  or  the  suggestion  of  using 
anaesthetics,  and  performing  a  dangerous  operation,  may 
sometimes  frighten  the  individual  into  confessing  im- 
posture. 2  In  some  obstinate  cases,  however,  all  means, 
even  of  a  severe  character,  fail  to  elicit  confession. 

Relation  of  Hypnotism  to  Crime. — The  question  of  the 
possibility  of  a  crime  being  committed  by  an  individual 
when  hypnotized  at  the  suggestion  of  another,  and  the 
responsibility  so  incurred  by  one  or  both,  is  still  one  of 
discussion.  It  is  true  that  experiments  have  been  made 
which  show  the  remote  possibility  of  crime  being  com- 
mitted under  such  circumstances,  as  in  the  case,  for  example, 

1  Malingerers  appear  to  have  been  as  common  in  ancient  as  in  mod- 
ern times.  Even  so  far  back  as  tbe  time  of  Galen  rules  were  given  for 
the  guidance  of  the  physician  in  detecting  such  frauds  {London  Med. 
Gazette,  vol.  17,  p.  989). 

2  Zacchias :  op.  cit.,  Lib.  iii.,  Tit.  ii.,  Quaest.  ii.,  p.  288. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      155 

of  a  hypnotized  woman  at  the  command  of  another  plunging 
a  dirk  into  a  manikin  dressed  up  as  a  woman.  But  it  must 
be  admitted  that  there  is  no  evidence  whatever  that  a 
murder  has  ever  thus  taken  place.1  In  hypnotized  persons, 
women  especially,  hysteria  constitutes  so  important  a  factor, 
and  hysteria  is  so  often  simulated,  that  it  would  become 
difficult  if  not  impossible  for  the  medical  examiner  to  state 
positively  to  what  extent  a  woman  acting  in  the  manner 
just  described  should  be  held  responsible. 

Life-insurance. — A  life-insurance  may  be  regarded  as  a 
contract,  the  deed  being  termed  a  policy,  whereby  a  company, 
in  consideration  of  a  premium  paid  in  instalments  or  in  a 
lump  sum,  agrees  to  pay  a  definite  sum  to  the  heirs  of  the 
insured  at  death,  or  at  some  definite  period  of  life.  In 
the  case  of  the  former,  the  amount  insured  for  being  pay- 
able only  at  death,  it  becomes  incumbent  upon  the  heirs  to 
prove  most  positively,  and  to  the  entire  satisfaction  of  the 
company,  that  the  insured  person  is  actually  dead.  For 
example,  in  cases  of  persons  who  have  disappeared,  who 
went  to  sea  and  were  never  heard  of  again,  questions  as  to 
presumption  of  death  or  of  survivorship  may  demand  the 
attention  of  the  medical  examiner.  The  question  as  to  the 
general  health  of  an  applicant  for  a  policy  of  insurance, 
the  tendency  to  disease  through  inheritance,  alcoholism, 
excessive  use  of  tobacco,  or  other  causes,  is  that  which 
brings  the  medical  profession  in  the  most  intimate  relation 
with  the  insurance  companies.     In  almost  all  the  lawsuits 

1  The  attention  of  the  writer  has  been  called  to  two  cases  of  murder, 
as  reported  in  the  daily  papers,  in  which  it  was  alleged  that  the  defence 
offered  was  that  the  accused  had  committed  the  crime,  when  hypno- 
tized, at  the  instigation  of  the  hypnotizer.  In  one  case  the  hypnotized 
was  adjudged  innocent  of  the  crime  of  murder,  the  hypnotizer  guilty. 


156  A   MANUAL   OP 

in  contested  life-insurance  policies  the  points  contested  are 
with  reference  to  what  was  actually  meant  by  certain 
medical  terms,  such  as  diseases,  habits  tending  to  shorten 
life,  etc. 

It  is  astonishing  what  a  difference  of  opinion  prevails 
among  even  intelligent  people  as  to  what  constitutes  a  tem- 
perate person,  many  an  individual  who  takes  several 
drinks  of  brandy  or  whisky  a  day  considering  himself  per- 
fectly temperate,  and  so  stating  to  the  medical  examiner, 
utterly  unconscious  of  his  health  being  gradually  under- 
mined, and  of  his  life  being  shortened  by  the  daily  use  of 
alcohol.  It  is  due  to  such  a  difference  of  opinion  as  to  the 
effect  of  alcohol  upon  the  system  that  the  question  of  in- 
temperance has  given  rise  to  so  much  discussion  in  cases 
of  life-insurance.  While  it  is  undoubtedly  true  that  there 
have  been  exceptional  instances  of  individuals  enjoying 
good  health  and  living  to  a  good  old  age  who  had  been  in 
the  habit  of  drinking,  and  more  particularly  whisky,  all 
their  lives,  nevertheless  it  cannot  be  denied  that,  as  a 
general  rule,  the  habitual  use  of  alcohol  in  perverting 
nutrition  induces  disease  of  the  heart,  liver,  and  kidneys, 
and  so  tends  to  shorten  life.  It  should  be  mentioned, 
however,  that  if  the  habits  of  the  individual  at  the  time  of 
insurance  were  temperate,  the  fact  that  intemperance  was 
subsequently  developed  would  not  debar  the  heirs  from 
recovery  upon  the  policy. 

What  has  just  been  said  of  the  use  of  alcohol  with 
reference  to  the  shortening  of  life  applies  equally  to  the 
influence  of  the  morphia  habit.  The  concealment  of  the 
fact  that  an  applicant  for  a  policy  of  life-insurance  was  an 
opium-eater  at  the  time  of  application  would  justify  the 
company  in  refusing  to  pay  the  heirs  the  insurance. 

There  is  no  doubt  that  insanity  also  tends  to  shorten 


MEDICAL  JURISPBUDENCE   AMD   TOXICOLOGY.      157 

life,  and  with  the  view  of  avoiding  future  complications 
which  might  arise  upon  this  point,  every  insurance  policy 
should  contain  a  direct  question  on  insanity;  the  insurance 
company  reserving  to  itself  the  privilege  of  insuring  or  not, 
according  to  the  particular  circumstances  of  the  case. 

Litigation  in  cases  of  life-insurance  not  unfrequently 
arises  in  consequence  of  the  insured  person  committing 
suicide  after  the  taking  out  of  the  policy.  Under  such 
circumstances  a  company  would  certainly  be  justified  in 
refusing  to  pay  the  insurance,  if  it  could  be  proved  that 
the  suicide  was  committed  with  the  intention  of  paying  off 
debts  or  leaving  money  to  the  heirs.  If,  however,  the 
suicide  was  due  to  insanity,  clearly  developed  after  the 
policy  had  been  taken  out,  the  heirs  would  undoubtedly 
be  entitled  to  the  payment  of  the  insurance. 

From  what  has  just  been  said  of  the  relationship  of  the 
alcohol  and  opium  habit,  insanity,  suicide,  to  life-insurance, 
it  is  obvious  that,  for  the  interest  of  the  company,  as  well 
as  for  that  of  the  insured,  a  most  thorough  examination 
should  be  made  as  to  the  health  of  the  individual  at  the 
time  of  the  application  for  the  policy.  Not  only  should 
all  the  printed  questions  of  the  policy  be  satisfactorily 
answered  by  the  applicant,  but  the  latter  should  be  most 
carefully  questioned  orally  by  the  medical  examiner  of  the 
company.  It  is  the  concealment  of  the  true  state  of  the 
health  of  the  applicant,  either  fraudulently  or  unintention- 
ally, at  the  time  that  the  policy  was  taken  out,  which  gives 
rise  to  most  of  the  lawsuits  in  cases  of  life-insurance. 

Medical  Malpractice. — Actions  for  damages  for  large 
amounts  are  so  often  brought  against  physicians  on  the 
charge  of  malpractice,  that  it  is  well  for  the  medical  pro- 
fession to  realize  that  the  law  affords,  even  to  the  most  dis- 
tinguished of  its  members,  under  such  circumstances,  no 


158  A    MANUAL   OF 

especial  protection.  In  order,  therefore,  to  avoid  the  annoy- 
ance and  loss  of  time  always  entailed  by  such  suits,  howso- 
ever they  may  terminate,  it  is  most  important  that  practi- 
tioners should  never  guarantee  or  contract  to  effect  a  cure, 
even  in  the  simplest  kind  of  cases.  Whatever  the  nature 
of  the  difficulties  arising  in  the  case  may  have  been,  however 
improbable  that  they  should  have  occurred,  or  that  they 
could  have  been  foreseen,  is  immaterial,  the  law  not  accept- 
ing any  such  excuses  for  the  failure  on  the  part  of  the  prac- 
titioner to  fulfil  his  contract  to  cure. 

Such  being  the  case,  how  unwise  would  it  be  for  a 
surgeon  to  promise  that  he  will  cure  a  deformity  when 
the  operation  involved  may  be  followed  by  pyaemia  and 
death  !  or  for  the  gynaecologist  to  guarantee  the  safe  re- 
moval of  an  abdominal  tumor  when  there  is  always  a  risk 
that  a  fatal  peritonitis  may  follow  the  operation !  All 
that  a  practitioner  can  be  expected  to  say  is  that  he  will 
do  the  best  he  can  for  his  patient.  The  law  only  demands 
that  he  will  exhibit  in  the  practice  of  his  profession  a  fair 
and  competent  degree  of  skill.  It  must  be  admitted,  how- 
ever, that  it  becomes  difficult,  if  not  impossible,  to  say, 
under  certain  circumstances,  just  what  constitutes  legally  a 
reasonable  or  ordinary  amount  of  professional  skill.  It 
is  evident  that  the  skill  indispensable  to  the  success  of  a 
physician  or  surgeon  practising  in  a  metropolis  must  be  far 
greater  than  that  demanded  of  one  practising  in  a  village. 
The  legal  term  ordinary  skill  is,  therefore,  far  from  being 
a  definite  one,  and  from  the  very  nature  of  the  case  must 
have  a  varied  application.  Not  only  ordinary  skill,  such 
as  is  demanded  in  the  successful  performance  of  a  surgical 
operation,  must  be  exhibited,  but  ordinary  care  and  attention 
in  the  after-treatment  must  be  paid  the  patient  as  well. 
The  bandaging,  the  dressings,  the  diet  must  be  all  care- 


MEDICAL   JUEISPRUDENCE    AND   TOXICOLOGY.      159 

fully  looked  after,  as  neglect  of  the  same,  involving 
possibly  the  occurrence  of  secondary  hemorrhage,  morti- 
fication, pysemia,  or  even  only  deformity,  will  render  the 
practitioner  justly  liable  to  a  suit  for  damages. 

On  the  other  hand,  a  practitioner  should  not  be  held 
responsible  for  not  prescribing  some  particular  remedy  or 
for  the  failure  of  some  one  remedy  to  cure,  since  the 
greatest  difference  of  opinion  prevails  among  therapeutists 
as  to  the  efficacy  of  all  so-called  "  remedies."  It  is  still 
a  question  among  medical  jurists  whether  a  practitioner 
renders  himself  liable  to  prosecution  in  deviating  some- 
what from  the  usual  manner  of  performing  an  operation, 
as,  for  example,  in  vaccinating  on  some  part  of  the  arm 
other  than  the  part  usually  selected  for  that  purpose.  As 
a  matter  of  fact,  it  may  be  mentioned,  however,  that  in  one 
instance  in  which  the  virus  was  introduced  nearer  to  the 
elbow  than  usual  and  serious  inflammation  followed,  the 
court  ruled  that  the  attending  physician  was  responsible  for 
all  the  bad  consequences  attending  the  case.  As  the  law 
recognizes  no  particular  school  of  medicine,  homceopathists, 
eclectics,  botanists,  herb  doctors  have  about  the  same  stand- 
ing legally  as  regular  members  of  the  profession.  Every 
practitioner  is  supposed,  however,  to  practise  according  to 
the  system  of  medicine  taught  in  the  school  of  which  he  is 
a  graduate.  It  might  be  supposed,  therefore,  that  if  a  vio- 
lent remedy  was  administered  or  a  surgical  operation  per- 
formed, by  an  individual  who  had  received  no  medical 
education  whatever,  in  the  event  of  serious  consequences, 
death  ensuing,  the  law  would  hold  such  a  person  crimi- 
nally responsible.  But,  strange  to  say,  there  have  been 
cases,  as,  for  example,  when  a  prolapsed  uterus,  being  mis- 
taken for  a  placenta,  was  torn  out  by  a  midwife  and  a 
fatal  hemorrhage  ensued ;  and  yet   the  court  ruled  that 


160  A   MANUAL  OF 

there  was  not  sufficient  evidence  to  convict  the  prisoner  of 
the  crime  of  murder,  and  he  was  acquitted.  It  is  to  be 
hoped,  since  the  law,  in  Pennsylvania  at  least,  requires 
the  registration  of  all  physiciaus,  that  any  one  convicted 
of  practising  medicine  without  the  diploma  of  a  reputable 
school  will  be  summarily  dealt  with. 

Medical  Registration. — In  this  connection,  for  the  benefit 
of  young  physicians  just  beginning  the  practice  of  their  pro- 
fession, it  does  not  appear  superfluous  to  quote  the  full  text 
of  the  registration  law  :  "  It  shall  be  the  duty  of  every  prac- 
tising physician  and  of  every  practitioner  of  midwifery,  on  or 
before  the  first  day  of  July  next  ensuing  (the  day  on  which 
the  law  goes  into  eifect),  to  report  his,  her  or  their  names  and 
places  of  residence  to  the  health  officer  at  the  office  of  the 
board  of  health,  and  it  shall  be  the  duty  of  the  health 
officer  to  have  the  same  properly  registered  in  index  form 
in  suitable  books.  In  the  event  of  any  of  the  persons  above 
specified  removing  to  any  other  place  of  residence,  it  shall 
be  their  duty  to  notify  the  health  officer  of  the  fact  within 
thirty  days  after  such  removal,  except  where  the  persons 
removing  shall  cease  to  act  in  such  official  capacity  as 
makes  them  subject  to  the  provisions  of  this  act." 

Suits  brought  against  physicians  for  malpractice  are 
usually  for  damages — civil  rather  than  criminal  in  char- 
acter. By  far  the  greater  number  of  such  cases  are  purely 
for  the  purpose  of  black-mail,  the  plaintiff  usually  securing 
the  services  of  counsel  with  the  understanding  that  if  he 
wins  the  suit,  his  fee  will  be  part  of  the  damages  awarded. 
Among  such  cases  may  be  mentioned  those  in  which  a 
shortening  of  a  limb,  the  stiffness  of  a  joint,  a  certain 
deformity  are  alleged  as  having  been  due  to  the  neglect 
of  the  surgeon  in  the  treatment  of  a  fracture  or  of  a  dis- 
location.     In   all   such  cases  it  is   incumbent  upon  the 


MEDICAL   JURISPRUDENCE  AND  TOXICOLOGY.      161 

plaintiff  to  prove  that  the  alleged  injury  or  disease;  was 
due  to  the  attending  surgeon,  and  that  the  same  might 
have  been  foreseen  and  avoided  by  proper  treatment. 
Malpractiee  can  only  be  proved  when  it  is  shown  that 
the  practitioner  has  set  aside  established  principles  and 
neglected  to  make  use  of  means  universally  held  by  the 
profession  to  be  necessary  in  a  given  case.  It  must  be 
shown,  however,  that  in  all  probability  the  treatment 
according  to  such  established  principles  would  accomplish 
the  desired  end,  that  such  treatment  never  proves  detri- 
mental, and  that  it  is  sanctioned  by  the  general  practice  of 
the  profession. 

It  should  be  mentioned  in  this  connection  that  gratuitous- 
ness will  not  exempt  a  practitioner  from  a  charge  of  mal- 
practice if  it  can  be  proved  that  his  treatment  was  im- 
proper, or  that  he  neglected  the  patient.  On  the  other 
hand,  a  patient  who  refuses  to  co-operate  with  his  physi- 
cian cannot  recover  damages  for  any  injury  so  sustained, 
unless  the  latter  can  be  shown  to  have  been  due  to  mal- 
practice. As  it  has  been  decided  that  a  physician  who 
takes  with  him,  to  a  confinement  case,  any  one  except  a 
physician  or  a  student  of  medicine,  renders  himself  liable 
for  damages;  except  in  cases  of  necessity,  it  would  be  well 
under  any  circumstances  for  him  to  obtain  the  consent 
of  the  patient  before  introducing  a  stranger  into  the  sick- 
room. 

In  connection  with  the  general  subject  of  medical  mal- 
practice it  may  be  mentioned  that  apothecaries  render 
themselves  liable  to  suits  for  damages  or  even  to  criminal 
prosecution,  if  it  can  be  shown  that,  through  their  igno- 
rance or  carelessness,  or  that  of  inexperienced  clerks  in  the 
putting  up  and  selling  of  medicines,  serious  or  fatal  con- 
sequences ensued. 
11 


162 


A   MANUAL   OF 


CHAPTER  XIV. 

Insanity — Varieties  of  Insanity — Idiocy — Mania — Dementia — Medico- 
legal Relations  of  Insanity — Criminal  Responsibility — Medico-legal 
Terms  in  Insanity — Feigned  Mental  Diseases. 


Insanity. — The  subject  of  insanity  has  so  extensive  a 
range  as  to  render  it  impossible  within  the  limits  of  this 
work  to  do  more  than  indicate  its  salient  features,  more 
especially  from  a  medico-legal  point  of  view.  Every 
practitioner  should  appreciate  the  importance  of  the  fact 
that  at  any  moment  he  may  be  called  upon  to  visit  a  person 
said  to  have  lost  his  reason,  and  should  be  qualified,  there- 
fore, to  express  an  opinion  as  to  his  sanity. 


Fig.  38. 


Fig.  39. 


Idiocy  (Feeeiee). 


Epileptic  Mania  (Fereiee). 


Varieties  of  Insanity. — Systematic  writers  upon  the  sub- 
ject of  insanity  differ  very  much  in  the  manner  in  which 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.       1  63 


they  classify  the  different  varieties  of  insanity.  For  our 
present  purpose  insanity  may  be  conveniently  regarded  as 
being  of  three  kinds — Idiocy  or  Amentia,  Mania,  and 
Dementia.1 


Insanity  - 


Amentia 


(  Imbecility 
1  Ic 


Idiocy 

Mania  Proper 

Melancholia 

Partial  Intellectual 

Moral 

Partial  Moral 

Kleptomania 

Pyromania 

Dipsomania 

Homicidal 

Suicidal 

Puerperal 


Dementia — Paralytic  (Paresis) 


Mania 


Idiocy  (Fig.  38)  differs  from  all  other  kinds  of  mental 
disease  in  being  congenital,  depending  upon  an  arrest  of 
cerebral  development.  There  are  various  degrees  of  it,  vary- 
ing from  a  condition  in  which  there  is  an  entire  absence  of 
mind  to  one  in  which  there  is  a  glimmering  of  intelligence, 
as  in  imbecility.  Imbeciles  are  usually  docile,  and,  in 
some  instances,  can  be  taught,  by  careful  management,  to 
talk  and  even  to  read.  The  causes  of  idiocy  are  usually 
syphilis,  intemperance  (of  the  parents),  consanguineous 
marriages.  Idiots  can  generally  be  recognized  by  the  small 
size  of  the  head  (except  in  the  case  of  congenital  hydro- 

1  Ray,  I. :  A  Treatise  on  the  3ledical  Jurisprudence  of  Insanity,  fifth 
edition,  1871,  pp.  84,  430,  577  ;  Georget :  Be  la  Folie,  Paris,  1820,  p.  101 ; 
Mandsley,  M.  D. :  Physiology  and  Pathology  of  the  Mind,  London,  1868, 
p.  253. 


164  A   MANUAL   OF 

cephalus,  in  which  the  head  is  very  large),  thickness  of  the 
lips,  enlargement  of  the  tongue,  salivary  glands,  and  tonsils, 
vaulting  of  the  hard  palate,  irregularity  of  the  teeth,  with 
tendency  to  decay,  deficiency  of  the  lobules  of  the  ear,  de- 
fective vision,  weakness  in  the  fingers  and  thumbs.  Idiots 
are  not  only  characterized  by  the  absence  or  deficiency  of 
intellectual  power,  but  also  by  undue  development  of  the 
animal  part  of  their  nature,  as  shown  by  their  filthy 
habits,  gluttony,  etc.  Upon  post-mortem  examination, 
the  convolutions  and  fissures  in  the  brain  of  an  idiot  are 
usually  found  less  numerous  and  less  complicated  in  their 
arrangement  than  in  the  brain  of  an  intelligent  person. 
Together  with  the  deficiency  of  the  gray  matter  of  the  cor- 
tex, due  to  so  simple  a  type  of  brain,  important  parts 
of  the  latter,  such  as  the  basal  ganglia,  corpus  callosum, 
cerebellum,  may  be  undeveloped  or  even  entirely  absent. 
Neither  idiocy  nor  imbecility  is  likely  to  be  mistaken  for 
mania  or  monomania,  for,  although  the  intelligence  in  the 
latter  conditions  is  perverted  and  irregular,  hallucinations 
being  common,  there  is  not  that  entire  absence  of  it  which 
is  so  characteristic,  of  idiocy.  However,  as  we  shall  see 
presently,  idiocy,  in  some  respects,  resembles  dementia. 
It  need  hardly  be  added  that  idiots  are  entirely  irrespon- 
sible, both  from  a  civil  and  criminal  point  of  view. 

Mania  (Fig.  39)  is  understood  as  a  general  perversion  of 
the  mental  faculties,  accompanied  usually  with  more  or  less 
excitement,  which  in  certain  cases  may  amount  even  to 
fury.  The  reasoning  powers  are  not  absolutely  lost,  but 
are  rather  confused,  disturbed,  disordered.  There  is  no 
orderly  sequence  of  thoughts;  ideas  follow  each  other 
without  any  relationship.  At  one  moment  the  maniac 
may  be  tractable,  pious  in  his  expressions,  singing  hymns ; 
at  another  ungovernable,  abusive,  blasphemous.    He  sings, 


MEDICAL  JURISPRUDENCE   AND  TOXICOLOGY.      165 

(lances,  laughs,  then  cries,  tears  off  his  clothes,  breaks  any- 
thing that  he  can  lay  his  hands  on,  often  at  such  times 
exhibiting  great  strength.  The  skin  is  dry  and  hot;  the 
eye  has  a  very  characteristic  expression,  a  fixed,  wild,  bril- 
liant sort  of  stare.  The  pulse  and  respiration  arc  usually 
quick  and  the  temperature  high.  The  appetite  is  generally 
voracious.  The  urine  and  feces  are  often  voided  involun- 
tarily. Sexual  desire  is  usually  increased,  and  when  so 
occurring  in  women  is  known  as  nymphomania;  in  men 
as  satyriasis. 

One  of  the  most  striking  features  of  mania  is  the  total 
alteration  wrought  in  the  feelings  of  one  so  affected  towards 
the  members  of  his  family;  the  maniac  becoming  suspicious 
of  and  hating  those  whom  he  had  formerly  naturally  loved. 
When  haunted  by  delusions,  which  is  not  unfrequently  the 
case,  he  may  become  so  dangerous  as  to  necessitate  physical 
restraint.  Systematic  writers  upon  the  subject  of  insanity 
consider  mania  to  be  of  different  kinds,  distinguishing  the 
varieties,  as  mania  proper  or  intellectual  mania,  which  we 
have  just  described,  melancholia,  partial  intellectual  mania, 
moral  mania,  partial  moral  mania,  kleptomania,  pyromauia, 
dipsomania,  and  homicidal,  suicidal,  puerperal  mania.  But, 
whatever  views  may  be  held  by  systematists  concerning  dif- 
ferent kinds  of  insanity,  moral,  emotional,  intellectual,  etc., 
it  should  be  understood  that  the  law  recognizes  only  one 
kind  of  insanity — that  which  affects  the  mind,  the  latter 
being  adjudged  as  unsouud  when  affected  with  delusions 
that  cannot  be  dispelled. 

Melancholia  may  be  regarded  as  a  variety  of  mania, 
differing  more  especially  from  the  latter  in  being  charac- 
terized by  depression  rather  than  excitement,  by  the  patient 
refusing  food  rather  than  partaking  of  it  eagerly.  The 
face  is  pale  and  pinched,  the  eyelids  droop,  the  pupils  are 


166  A    MANUAL  OF 

dilated.  The  patient  sits  for  hours  at  a  time  doing  noth- 
ing, brooding  over  melancholy  thoughts ;  he  is  often  of  a 
religious  nature,  suspicious  of  being  persecuted,  burned, 
poisoned,  etc.,  often  dirty  in  habits,  soiling  his  clothes  and 
linen,  utterly  indifferent  to  his  personal  appearance. 

Partial  intellectual  mania  is  characterized  by  the  fact 
that  the  person  who  suffers  from  this  form  of  mental  dis- 
ease is  possessed  of  some  one  notion  contrary  to  his  own 
experience,  as  well  as  to  all  common  sense.  He  may 
imagine  that  his  stomach  is  full  of  lizards  and  snakes;  or, 
if  the  individual  be  a  woman,  that  her  uterus  contains 
hydatids,  and  that  she  is  pregnant  by  the  devil,  as  was 
believed  in  a  well-known  case.1 

As  it  is  still  a  question  whether  there  is  any  such  form 
of  mania  as  moral  mania,  that  is,  of  a  morbid  perversion 
of  the  natural  affections,  temper,  and  habits  of  an  individual 
without  any  noticeable  derangement  of  the  intellect,2 it  is 
only  necessary,  in  this  connection,  to  say  that  no  sudden 
outburst  of  this  form  of  mania  should  be  admitted  as  ex- 
cusing or  palliating  any  crime.  There  are  no  well-authenti- 
cated cases,  for  example,  of  persons  becoming  suddenly 
affected  with  an  insane  desire  to  commit  murder,  and  unless 
it  can  be  clearly  shown  that,  previously  to  the  commission 
of  such  a  crime,  the  defendant  had  given  evidence  of  being 
insane,  the  plea  of  moral  insanity  should  not  be  enter- 
tained by  the  court,  but  the  defendant  should  be  punished  to 
the  full  extent  of  the  law. 

Kleptomania,  or  the  disposition  to  steal,  is  exhibited  so  often 
by  persons  in  good  circumstances  that  this  peculiarity  cannot 

1  Esquirol,  E. :  Des  Maladies  mentales,  tome  premier,  Paris,  1838,  p. 
495. 

2Pritchard:  Treatise  on  Insanity,  1837,  p.  16;  Pinel:  Traite  medico- 
philosophique  sur  I' Alienation  mentale,  deuxieme  edition,  Paris,  1809,  p. 
155. 


MEDICAL  JURISPRUDENCE   AND  TOXICOLOGY.      107 

be  attributed  to  want,  but  to  some  aberration  of  the  intellect. 
In  all  trials  of  kleptomaniacs,  it  must  be  proved  that  the 
defendant  is  incapable  of  appreciating  what  constitutes  the 
crime  of  theft;  otherwise  the  plea  of  this  form  of  insanity 
would  be  the  favorite  defence  of  all  professional  thieves. 

Pyromania,  or  the  insane  desire  to  set  fire  to  anything, 
barns,  dwelling-houses,  churches,  is  a  less  common  form  of 
mania  than  kleptomania.  It  appears  to  be  ofteu  associated 
with  epileptic  insanity.  No  doubt  this  form  of  mania,  like 
the  so-called  "  moral  mania,"  is  made  a  convenient  plea  for 
the  defence  of  crime,  as  in  cases  of  arson.  Dipsomania, 
or  the  craving  for  drink,  differs  from  the  desire  for  liquor 
shown  by  those  who  indulge  daily  in  the  use  of  alcohol 
in  the  circumstance  that  it  is  followed  by  long  remissions 
in  the  thirst  for  it.  During  these  periods  there  is  not  only 
no  desire,  but  often  a  loathing,  for  it.  With  the  return  of 
the  craving,  the  individual  will  literally  soak  himself  with 
spirits  for  days  and  weeks  at  a  time,  often  secluding  him- 
self and  shunning  society  of  all  kinds. 

In  this  connection,  the  responsibility  of  drunkards  may 
be  as  appropriately  considered  here  as  elsewhere.  Undoubt- 
edly, irresponsibility  would  be  inferred  by  the  law  in  the 
case  of  a  person  whose  mind  had  been  weakened  by  habitual 
drinking,  unless  it  could  be  shown  that,  at  the  moment  of 
the  commission  of  an  act — such  as  the  signing  of  a  deed — 
the  individual  was  fully  conscious  of  the  nature  of  the 
contract.  A  murder  committed  by  a  drunken  man  would 
not  be  excused,  however,  by  the  law,  if  he  had  got  volun- 
tarily drunk  before  perpetrating  the  crime.  If  it  could  be 
proved,  however,  under  such  circumstances,  that  his  mind 
had  been  hopelessly  diseased  by  drink,  he  would  be  held 
irresponsible.  In  all  such  trials,  an  extenuating  circum- 
stance would  be  the  fact  that  the  defendaut  had  no  grudge 


168  A   MANUAL,   OF 

or  malice  against  the  deceased,  but  Lad  committed  the 
murder  when  under  the  influence  of  drink.  It  may  be 
mentioned,  in  connection  with  the  responsibility  of  drunk- 
ards, that  somnambulists  cannot  be  held  responsible  for  their 
acts,  for,  in  such  a  condition  as  that  of  somnambulism,  there 
can  be,  from  the  very  nature  of  the  case,  no  motives  to 
commit  crime,  the  intellect  being  in  abeyance. 

Homicidal  mania  is  characterized  by  an  irresistible 
impulse  to  commit  murder.  In  instances  of  this  kind 
of  insanity,  it  will  be  generally  learned,  from  the  previous 
history  of  the  case,  that  the  individual  had  been  injured 
at  some  previous  period,  as  by  a  fall  upon  the  head,  in 
consequence  of  which  he  had  become  more  or  less  morose 
and  melancholic  at  times.  The  maniac  may  murder  a 
number  of  persons  at  once,  the  victims,  not  unfrequently, 
being  members  of  his  own  family,  to  whom  he  had  been 
previously  devotedly  attached ;  there  is  an  entire  absence 
of  motive  to  commit  the  crime.  Further,  the  maniac 
makes  no  effort  to  escape  from  the  consequences  of  his  act, 
as  an  ordinary  sane  murderer  would  do.  He  may  even 
boast  of  what  he  has  done,  saying  that  he  had  been  directly 
inspired  to  do  what  he  did. 

Suicidal  mania,  known  also  as  monomania,  is  exhibited 
in  the  disposition  to  take  one's  own  life.  While,  in  most 
cases  of  suicide,  the  verdict  of  the  coroner's  jury — the 
latter  actuated,  no  doubt,  by  kindly  feelings  for  the  family 
of  the  deceased — is  death  by  his  or  her  hands  while  labor- 
ing  under  temporary  insanity,  there  can  be  no  doubt  that 
perfectly  sane  persons  commit  suicide.  In  ancient  times  it 
was  a  common  custom  for  persons  who  were  at  war  to  take 
their  own  lives  rather  than  take  the  chances  of  falling  into 
the  hands  of  their  conquerors  and  run  the  risk  of  torture 
and  death.     It  is  a   matter  of  everyday  occurrence  for 


MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY.      169 

men  who  have  failed  in  business  to  commit  suicide  rather 
than  to  face  their  creditors,  disaster,  and  financial  ruin. 
Indeed,  so  many  suicides  are  committed,  not  only  intention- 
ally, but  intelligently,  that  it  becomes  very  often  difficult 
to  say  that  the  self-destruction  was  due  to  insanity.  The 
disposition  to  commit  suicide  is,  in  many  instances,  un- 
doubtedly inherited,  inasmuch  as  it  is  well  known  that  the 
members  of  certain  families  for  generations  have  been  in 
the  habit  of  taking  their  own  lives.  A  remarkable  feature 
in  suicide  is  the  regularity  with  which  it  occurs,  and  the 
frequency  with  which  it  is  committed  in  the  same  way. 
Indeed,  under  certain  circumstances,  the  perpetration  of 
the  act  and  the  uniformity  of  the  means  by  which  it  is 
accomplished  may  not  inappropriately  be  said  to  be 
epidemic.1 

Puerperal  insanity,  which  is  one  of  the  most  distressing 
kinds  of  mania,  attacks  women  after  delivery,  within  a 
period  varying  from  a  few  days  to  several  weeks.  It 
occurs  usually  before  the  stoppage  of  the  lochia ;  albu- 
min appears  in  the  urine,  and  the  flow  of  milk  is  sup- 
pressed. A  woman  suffering  from  this  form  of  mania 
may  be  either  foul-mouthed  or  taciturn  and  pious  in  her 
talk,  and  may  often  be  troubled  with  religious  delu- 
sions. She  may  either  totally  neglect  her  infant,  or 
take  such  a  dislike  to  it  that  she  sooner  or  later  destroys 
it,  and  frequently  in  the  most  horrible  manner.  It  should 
be  remembered,  therefore,  by  the  medical  jurist,  that,  in 
certain  cases  of  infanticide,  the  mother  may  have  been 
afflicted  with  puerperal  insanity,  and  that  under  such  cir- 
cumstances she  should  not  be  held  responsible  for  the  con- 
sequences of  her  actions. 

1  Buckle :  History  of  Civilization  in  England,  chap.  i.  p.  25 ;  Morselli, 
H. :  Suicide:  An  Essay  on  Comparative  Moral  Statistics,  Kew  York,  188:2. 


170  A    MANUAL  OF 

Dementia  (Fig.  40),  beginning  with  a  simple  enfeeblernent 
of  the  intellect,  terminates  with  an  entire  extinction  of  the 

Fig.  40. 


Dementia  (Paresis)  (Ferrier). 

mental  powers.  This  form  of  disease  is  characterized  by 
absence  of  ideas,  accompanied  by  depression,  rather  than,  as 
in  mania,  by  exaggerated  mental  activity,  with  excitement. 
It  may  follow  acute  mania  or  melancholia ;  is  often  due  to 
disease  of  the  brain,  the  result  of  injury,  and  is  frequently 
incidental  to  old  age.  The  countenance  in  dementia  is 
pale,  and  the  expression  is  a  peculiarly  vacant  one.  A 
most  striking  feature  is  loss  of  memory,  the  patient,  in  an 
advanced  stage  of  the  disease,  forgetting  even  what  has 
transpired  within  a  moment  or  two.  Individuals  affected 
with  this  disease  act  in  an  undecided,  silly,  childish 
manner,  repeating  themselves  in  conversation,  appearing 
neither  to  like  nor  dislike  their  former  friends  and  associates, 
moving  about  in  an  aimless,  listless  way.  A  disposition 
is  often  exhibited  in  this  disease  to  hoard  up  articles  of  no 
value. 

Paralytic  dementia,  also  known  as  general  paralysis  or 
paresis  of  the  insane,  appears  to  be  due  more  especially  to 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      171 

disease  of  the  gray  matter  of  the  convolutions  of  the  brain. 
This  form  of  disease  may  be  caused  by  syphilis,  alcoholism, 
excessive  mental  work.  The  first  symptoms  of  general 
paresis  of  the  insane  arc  a  certain  fretfulness,  irritability 
of  manner,  accompanied  by  carelessness  in  dress,  etc. 
The  patient  becomes  deluded  with  the  idea  of  being 
possessed  of  great  wealth  or  great  physical  strength.  As 
the  disease  advances,  the  muscular  power  becomes  much 
weakened,  and  the  gait  unsteady.  The  tongue  trembles 
when  protruded,  the. lips  are  tremulous,  and  difficulty 
is  experienced  in  pronouncing  certain  words.  Vision 
becomes  affected.  A  bloody,  gelatinous-like  swelling  of 
the  ear  develops,  the  so-called  "  hsematoma  aims,"  the 
contents  of  which,  resembling  the  extravasations  under 
the  dura  mater  in  pachymeningitis,  appear  to  be  due  to  a 
degeneration  of  the  branches  of  the  carotid  artery.  The 
prognosis  in  general  paresis  of  the  insane  is  always  un- 
favorable, death  taking  place  within  a  period  varying  from 
two  to  ten  years. 

Medieo-Legal  Relations  of  Insanity. — Having  de- 
scribed, in  a  geueral  way  at  least,  the  most  important 
forms  of  mental  disease,  it  remains  now  to  consider 
them  in  their  medico-legal  relations.  Should  a  per- 
son be  determined  to  be  insane,  the  first  question  to  be 
considered  is  as  to  the  decree  of  the  insanity,  and  more 
especially  as  to  the  civil  and  criminal  responsibility  of 
the  individual.  As  out  of  this  twofold  inquiry  arise  all 
medico-legal  questions  of  insanity,  there  should  be  no 
misunderstanding  as  to  what  is  meant  by  civil  and 
criminal  responsibility.  Civil  responsibility  implies  the 
capability  of  managing  one's  own  business,  taking  an 
intelligent  part  in  the  ordinary  affairs  of  civil  life, 
making    contracts,    wills,    etc.      Criminal    responsibility 


172  A    MANUAL   OF 

renders  the  perpetrator  of  any  crime,  such  as  theft,  arson, 
murder,  liable  to  punishment,  supposing  the  person  suf- 
ficiently sane  at  the  time  of  the  commission  of  the  deed 
to  be  held  responsible.  In  all  cases  of  insanity  the 
practitioner  who  assumes  the  responsibility  of  giving  ad- 
vice should  have  had  a  great  deal  of  experience  in  treat- 
ing insanity,  and  should  exercise  great  caution  before  he 
advises  that  a  person  should  be  deprived  of  his  liberty 
and  placed  under  restraint.  Before  positively  expressing 
the  opinion  that  the  patient  is  insane,  and  setting  forth  the 
facts  upon  which  such  an  opinion  is  based,  the  physician 
should  satisfy  himself,  beyond  doubt,  that  the  person 
alleged  to  be  insane  is  really  so.  Not  only  one  visit,  but 
several  visits  may  have  to  be  made  before  all  doubts  as  to 
the  insanity  of  the  patient  are  removed.  In  case  the 
practitioner  advises  that  the  patient  be  treated  at  home,  it 
should  be  distinctly  understood  that  he  is  relieved  of  all 
responsibility  for  the  restraint,  that  being  assumed  by  the 
friends  or  the  members  of  the  family.  The  form  of  cer- 
tificate by  which  an  insane  person  can  be  removed  to  an 
asylum  is  fixed  by  statute,  and  no  other  form  is  valid  in 
America.  In  Pennsylvania  the  certificate  must  be  signed 
by  two  respectable  physicians,  who  have  practised  medi- 
cine for  five  years,  both  of  whom  must  have  examined  the 
patient  within  one  week  of  their  signing  the  certificate,  and 
who  both  must  testify  under  oath  that  it  is  absolutely 
necessary  for  the  safety  of  the  individual  and  the  public 
that  the  patient  shall  be  placed  under  restraint  in  an 
asylum.  The  physicians  signing  the  certificate  should  not 
be  related  by  blood  or  marriage,  or  be  officially  connected 
in  any  way  with  the  asylum  in  which  the  patient  is  to  be 
confined.  Practitioners  cannot  be  too  cautious  in  signing 
a  certificate  for  the  placing  of  a  patient  in  an  insane 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      1 7.'i 

asylum,  false  commitment  rendering  them  liable  to  heavy 
punishment  by  an  action  at  law.  It  should  be  remem- 
bered that,  in  many  instances,  physicians  have  been  de- 
ceived by  relatives  interested  in  the  management  or  dis- 
posal of  an  estate,  and  induced  by  their  misrepresentations 
of  the  state  of  mind  of  the  patient  to  sign  a  certificate  con- 
signing him  or  her  to  an  insane  asylum. 

Judgment  and  caution  must  be  exercised  in  signing  the 
discharge  of  a  patient  from  an  asylum  by  the  physician  in 
charge,  as  well  as  in  signing  one  of  commitment.  Patients 
are  usually  removed  from  an  asylum  by  the  members 
of  their  family  or  friends  at  the  discretion  and  with  the 
approval  of  the  superintendent.  In  America  there  is  no 
law  preventing  the  liberation  of  the  insane  on  recovery, 
except  in  cases  of  homicidal  lunatics,  who  have  been  com- 
mitted to  an  asylum  by  an  order  of  the  court. 

The  opinion  of  the  practitioner  is  occasionally  asked 
as  to  the  capacity  of  an  individual  to  make  a  will,  to 
sign  a  contract,  or  to  many.  It  should  be  remembered, 
strange  as  it  may  appear,  that  less  mental  capacity  is 
required  by  law  to  make  a  will  than  to  permit  the 
managing  of  property  or  the  enjoyment  of  personal 
liberty.  The  courts  have  ruled  in  many  instances 
that  patients,  even  when  confined  in  iusane  asylums, 
have  made  good  wills,  and  have  held  as  valid  the 
most  absurd  wills,  it  having  been  shown  that  such  wills 
were  in  perfect  accordance  with  the  life  of  the  eccen- 
tric, but  not  therefore  necessarily  insane,  testator.  In 
order,  however,  that  a  will  should  be  valid,  the  law 
requires  that  the  testator  should  be  sane,  at  least  at  the 
time  of  the  making  of  the  will.  A  will  made  when  the 
testator  was  under  the  influence  of  liquor,  or  narcotized, 
or  afflicted  with  the  delirium  of  fever,  would  not  be  held 


174  A    MANUAL   OF 

as  valid.  A  person  would  not  be  disqualified,  however, 
from  making  a  will  when  poisoned  by  arsenic  or  strych- 
nia, provided  his  mind  was  clear,  and  the  same  may  be 
said  of  a  person  suffering  from  typhoid  fever,  paralysis, 
or  epilepsy.  When  a  physician  is  consulted  as  to  the 
capacity  of  a  person  to  make  a  will,  the  examination  of 
the  testator  should  be  made  in  private,  or  only  in  the 
presence  of  the  nurse,  or  perhaps  of  one  member  of  the 
family.  The  physician  should  satisfy  himself  that  the 
testator  is  not  under  the  influence  of  liquor,  or  of  any 
drug;  that  he  fully  realizes  the  importance  and  the 
nature  of  the  act  he  is  about  to  perform  ;  that  he  is  not 
affected  by  any  delusions  ;  and  that  no  undue  influence  has 
been  brought  to  bear  upon  him. 

A  most  delicate  question  for  the  physician  to  answer, 
and  his  advice  is  often  asked  upon  the  subject,  is  that  of 
the  propriety  of  one  person  marrying  another  who  has 
been  insane,  or  in  whose  family  insanity  is  hereditary. 
While,  as  a  general  rule,  all  marriages  of  such  a  character, 
as  well  as  those  in  which  there  is  a  tendency  in  the  con- 
tracting parties  to  inherit  any  disease,  are  to  be  discouraged, 
any  advice  to  the  contrary  that  may  be  given  by  the 
physician  will  not  prevent  their  taking  place,  and  nothing 
will  be  gained  by  his  opposition.  The  family  physician  is 
often  called  upon  to  give  advice  as  to  the  best  means  of  bring- 
ing up  children  begotten  by  such  unfortunate  marriages. 
Hygienic  treatment  is  all  that  can  be  recommended  in 
such  cases.  It  ought  to  be  insisted  upon,  however,  that 
the  children  should  have  pure  country  air,  plenty  of 
out-door  exercise,  plain  but  nutritious  food ;  that  all  ex- 
citement, especially  at  the  age  of  puberty,  should  be 
avoided ;   and,  above  all,  that  little  or  no  mental  effort 


MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY.      175 

should  be  required,  even  though  the  child  should  thereby 
grow  up  comparatively  uneducated. 

Criminal  Responsibility  of  the  Insane. — Of  nil  the  ques- 
tions which  the  subject  of  legal  medicine  gives  rise  to, 
there  is  none  more  difficult  or  more  worthy  of  consid- 
eration than  that  of  the  relations  of  insanity  to  criminal 
responsibility.  In  nearly  every  trial  for  homicide,  how- 
ever brutal  or  revolting  the  crime,  no  matter  how  out- 
rageous or  aggravated'  the  circumstances  may  be,  after 
every  other  plea  has  been  urged,  the  defence,  as  a  last 
resource,  attempts  to  prove  that  the  murderer  was  insane. 
It  might  be  supposed  that  the  sophistry,  flimsy  rubbish, 
unworthy  of  being  dignified  by  the  name  of  argument, 
advanced  by  adroit  counsel,  could  speedily  be  disposed 
of  in  all  such  cases  by  limiting  the  discussion  to  simply 
determining  whether  the  defendant  was  afflicted  with 
any  mental  disorder  due  to  disease.  The  difficulty, 
however,  which  at  once  arises  consists  in  deciding  what 
shall  constitute  a  test  of  the  existence  of  a  mental  dis- 
order. At  one  time  it  was  universally  admitted  that  an 
individual  was  responsible  unless  totally  deprived  of  his 
understanding  and  memory — not  knowing  what  he  was 
doing  any  more  than  an  infant,  brute,  or  wild  beast.  The 
knowledge  of  right  and  wrong  was  later  considered  as  a 
test  of  responsibility  in  criminal  cases.  This  test  was 
afterwards  so  qualified  that  the  knowledge  of  right  and 
wrong  was  to  have  relation  only  to  the  particular  act  of 
which  the  individual  was  accused ;  and  it  was  still  fur- 
ther modified  in  its  being  held  that  the  person  accused 
must  have  a  knowledge  of  the  consequences  of  the  act. 
There  can  be  no  doubt,  however,  that  insane  persons 
have  not  only  been  fully  conscious  of  the  criminality 
of    their   acts,    but   have    realized   as   well   their   conse- 


176  A   MANUAL   OF 

quences    and    the    punishment  to   which    they   rendered 
themselves  liable. 

The  knowledge  of  right  and  wrong,  the  consciousness 
of  criminality,  the  realization  of  liability  to  punishment 
being  possessed  by  insane  persons,  have  in  recent  times 
led  to  the  claim  that  only  those  individuals  should  be  held 
irresponsible  who  have  lost  all  power  of  control  over 
their  actions.  The  test  of  irresponsibility  may  be  said  to 
be,  in  this  view  then,  the  proof  of  a  want  of  will-power — 
the  power  of  choosing  between  good  and  evil  being  de- 
stroyed by  disease.  The  accused  would  not,  however,  be 
held  irresponsible  if  the  crime  was  committed  under  the 
influence,  temporarily,  of  liquor,  or  of  a  violent  burst  of 
passion,  the  latter  condition  being  often  attributed  to  im- 
pulsive or  emotional  insanity — a  form  of  mental  disorder 
for  the  existence  of  which  there  is  no  evidence. 

Not  unfrequently,  medical  experts  in  insanity  are  also 
called  upon  by  the  courts  to  state  whether  a  criminal 
under  sentence  of  death  is  insane,  in  order  to  stay  exe- 
cution. 

Medico-Legal  Terms  Defined. — In  connection  with  cases 
of  insanity  certain  legal  terms  are  frequently  made  use  of 
rather  loosely,  such  as  illusions,  hallucinations,  delusions, 
lucid  intervals;  but  these  terms  should  be  defined,  in 
order  that  the  medical  examiner  may  be  qualified  to 
answer  intelligently  in  court  questions  involving  their 
use.  An  illusion  may  be  defined  as  a  false  impression 
due  to  a  material  basis,  the  impression  being,  however, 
distorted  through  some  defect  in  the  avenue  of  sense, 
or  of  the  perceptive  centre,  as  in  the  mistaking  a  tree 
for  a  man  at  night.  Hallucinations  differ  from  illusions 
in  being  perverted  impressions,  but  without  a  material 
basis,  at  least  immediately.     A  person  afflicted  with  this 


MEDICAL   JUEI8PEUDENCE   AND   TOXICOLOGY.       177 

disorder  imagines  lie  hears  .strange  voices,  sees  people 
where  there  are  none,  etc.  Delusions  may  ho  defined  as 
beliefs  in  something  purely  imaginary,  as  when  a  pauper 
imagines  he  has  become  a  millionaire,  or  when  a  million- 
aire believes  he  lias  lost  everything.  Should  a  delusion  be 
so  strong  as  to  affect  the  disposal  of  an  estate  by  will,  as 
when  a  parent  has  come  to  hate,  for  no  reason,  his  chil- 
dren, whom  he  had  formerly  loved,  the  capacity  to  make 
a  will  should  be  disputed.  If,  however,  the  delusion  with 
which  an  individual  is  affected  is  not  connected  in  any 
way  with  the  act  about  to  be  performed,  the  responsibility 
of  such  a  person  would  not  be  questioned.  By  a  lucid 
interval  is  meant  a  temporary  intermission  of  insanity, 
during  which  period  the  individual  recovers  his  reasoning 
powers.  It  may  last  for  months,  weeks,  or  only  for  a  few 
minutes.  It  not  unfrequently  occurs  in  mania,  and  occa- 
sionally in  dementia,  but  never  in  idiocy  or  imbecility. 
Duriug  a  lucid  interval  the  law  recognizes  the  power  of  a 
person  to  sign  a  contract,  to  make  a  will,  to  exercise  civil 
rights,  etc. 

Feigned  Mental  Diseases  are  usually  considered  by 
Writers  upon  medical  jurisprudence  separately  from 
feigned  bodily  disorders.  The  expression  mental  dis- 
ease, whether  feigned  or  not,  regarded  as  something  dis- 
tinct from  bodily  disease,  is,  however,  an  unphilosophical 
one,  as  there  can  be  no  disease,  mental  or  otherwise, 
without  some  underlying  change  in  organization.  What- 
ever may  be  the  psychological  views  held  as  to  the 
nature  of  mind,  whether  it  be  regarded  as  an  entity,  a 
something  independent — superadded  to  the  body — an 
almost  obsolete  view  now — or  as  a  function  of  the  nervous 
system,  and,  more  especially  in  man,  of  the  cerebral  por- 
tion of  it,  a  view  accepted  by  all  physiologists,  is  immate- 

12 


178  A    MANUAL    OF 

rial,  at  least  as  far  as  it  affects  the  view  universally 
accepted  that  a  healthy  mind  is  always  found  in  a  healthy 
body. 

In  connection  with  the  subject  of  insanity,  and  as  a 
mere  matter  of  convenience,  the  subject  of  feigned  mental 
diseases  may  be  as  appropriately  considered  here  as  else- 
where. Mental  diseases  are  most  frequently  feigned  by 
criminals,  in  the  hope  of  escaping  imprisonment  or 
capital  punishment.  It  is  frequently  very  difficult  to 
prove  in  such  cases  that  the  criminal  is  malingering,  in- 
sanity in  one  form  or  another  being  so  well  imitated. 
The  criminal  may  keep  up  the  deception  for  months,  dur- 
ing which  he  may  rave,  beat  the  door,  tear  up  his  clothes 
and  bedding,  indulge  in  the  foulest  language  and  dirty 
habits,  conduct  himself  in  so  outrageous  a  mauner  as  to 
necessitate  the  use  of  a  strait-jacket — and  even  then  not 
confessing  the  fraud.  In  the  investigation  of  these  cases 
it  is  most  important  to  determine  whether  the  individual 
has  any  motive  in  simulating  insanity — such  as  that  of 
escaping  punishment  for  some  crime.  Another  point  to 
be  determined  is,  whether  the  particular  crime  committed 
was  incidental  to  a  life  of  crime,  perhaps  the  last  act  of  a 
long  series  such  as  a  hardened  criminal,  but  not  an  insane 
person,  might  be  expected  to  commit.  Another  point  to 
be  ascertained  is,  whether  the  culprit  endeavored  to  escape, 
it  being  well  known  that  insane  persons  exhibit  a  perfect 
indifference  to  the  consequences  of  their  acts.  It  should 
be  also  remembered  that  insane  persons  never  admit  that 
they  are  insane ;  whereas,  those  simulating  insanity  are 
always  anxious  to  impress  every  one  with  the  fact  that  they 
are  really  insane.  Of  the  different  forms  of  insanity 
mania  is  that  which  is  usually  feigned  by  malingerers. 
As  all  maniacs  are  popularly  supposed  to  be  violent,  the 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.       17!) 

malingerer  in  attempting  to  simulate  mania  is  particularly 
so,  usually  overacting  the  part;  while  the  impostor,  how- 
ever, usually  sleeps  soundly,  the  maniac  is  as  violent  by 
night  as  by  day.  Dementia  is  less  rarely  simulated  than 
mania,  as  it  is  more  difficult  to  imitate,  while  the  fraud 
is  more  readily  recognized,  being  at  once  disclosed  by  the 
slightest  reasoning  power  manifested  by  the  individual. 


180  A   MANUAL  OP 


PART  II.  TOXICOLOGY. 


CHAPTER   I. 

Frequency  of  Death  from  Poisoning — Definition  of  a  Poison — Mode  of 
Action  of  Poisons — Influence  exerted  on  Action  of  Poisons  by  Habit, 
Sleep,  Disease,  etc. — Evidences  of  Poisoning  derived  from  Symptoms, 
Post-mortem  Appearances,  Chemical  Analysis,  Experiments  upon 
Animals,  Circumstantial  Evidence — Character  of  the  Evidence  the 
Chemical  Expert  may  be  Expected  to  give  in  Cases  of  Poisoning. 

In  most  cases  of  poisoning  the  duty  of  the  physician 
making  the  post-mortem  examination  is  usually  limited 
simply  to  removing  the  stomach,  intestines,  etc.,  of  the 
deceased  person  supposed  to  have  been  poisoned,  and 
placing  them  in  the  hands  of  the  chemist  especially 
employed  by  the  Commonwealth  to  make  an  exam- 
ination of  their  contents,  with  the  view  of  deter- 
mining the  cause  of  death.  It  is  important,  how- 
ever, that  every  physician  should  have  some  knowledge 
of  toxicology ;  that  is,  of  the  symptoms  of  poisoning, 
the  nature  of  poisons,  their  antidotes,  etc.,  as  well  as  of 
the  medical  relations  of  the  subject.  The  subject  of  toxi- 
cology, like  that  of  insanity,  is  such  an  extensive  one  that 
its  thorough  consideration  would  demand  a  special  treatise, 
far  exceeding  the  scope  of  the  present  work.  All  that  the 
author  can  hope  to  accomplish  within  his  prescribed  limits 
is  to  point  out,  in  a  very  general  way,  what  his  own  ex- 
perience suggests  as  to  the  kind  of  toxicological  knowledge 
the  medical  expert,  who  is  not  an  analytical  chemist,  should 
possess. 


MEDICAL    JURISPRUDENCE    AND    TOXICOLOGY.      181 

The  readiness  with  which  poisons  may  be  obtained,  the 
facility  of  administering  them,  the  close  resemblance  which 
the  symptoms  and  post-mortem  appearances  of  poisoning 
frequently  hear  to  those  due  to  disease,  account  for  the  fact 
that  so  many  homicides  and  suicides  are  committed  by  this 
means.  Indeed,  statistics  show  that,  excepting  the  casual- 
ties due  to  war,  poisoning  is  the  most  frequent  of  all  the 
causes  of  violent  death. 

Poison  Defined. — A  poison  may  be  defined  as  a  sub- 
stance which,  introduced  into  the  body  in  a  state  of  health, 
by  the  mouth,  rectum,  skin,  lungs,  etc.,  ordinarily  causes 
illness  and  often  death,  the  injurious  effects  not  being  due, 
however,  to  purely  mechanical  action.  According  to  the 
above  definition,  a  substance  would  not  be  a  poison  which 
only  affected  a  person  when  suffering  from  disease  like 
that  of  gastritis,  rendering  him  peculiarly  susceptible, 
which  is  due  to  personal  idiosyncrasy.  Nor  would  frag- 
ments of  glass,  or  iron,  or  other  hard  or  sharp  substances 
be  classified  as  poisons,  even  though  they  should  cause 
death  when  swallowed,  the  injurious  effects  experienced 
being  due  to  mechanical  action.  It  need  not  be  added 
that  the  particular  amount,  large  or  small,  of  a  substance 
necessary  to  cause  death  affords  no  basis  for  distinguishing 
certain  substances  as  poisons  from  others  which  are  not 
poisons.  Half  an  ounce  of  oxalic  acid  may  prove  as  fatal 
as  half  a  grain  of  strychnia.  The  effects  of  poisons  are 
both  local  and  remote.  In  making  an  impression  directly 
upon  the  part  of  the  body  with  which  the  poison  comes  in 
contact,  a  poison  acts  locally ;  in  affecting  some  distant 
part  of  the  body  it  acts  remotely.  Certain  poisons  act 
both  locally  and  remotely — arsenic,  for  example,  affecting 
the  stomach  locally,  aud  the  brain  remotely.  In  order 
that  a  poison  should  produce  its  effects,  unless  it  be  a  cor- 


182  A   MANUAL   OF 

rosive,  it  must  be  absorbed — pass  into  the  blood.1  That 
poisons  are  absorbed  is  proved  by  their  being  found  in  the 
blood,  brain,  and  viscera.  The  rapidity  with  which  this 
takes  place  will  depend  upon  their  solubility  and  the  rela- 
tive fullness  of  the  bloodvessels.  Absorption  will,  there- 
fore, be  favored  by  bleeding  or  purging  through  depletion 
of  the  vascular  system.  The  effects  of  a  poison  injected 
directly  into  the  blood  are  almost  instantaneous. 

Mode  of  Action  of  Poisons. — A  poison  having  once 
passed  into  the  blood  is  carried  by  the  latter  throughout 
the  system,  being  either  eliminated  with  the  bile,  urine, 
saliva,  pancreatic  juice,  and  sweat,  or  deposited  in  the 
liver,  spleen,  kidneys,  heart,  lungs,  brain,  pancreas,  mus- 
cles, or  bones.  Every  organ  would  appear,  therefore,  to 
have  a  peculiar  affinity  for  some  one  or  more  poisons,  as 
shown  either  by  the  poison  being  excreted  by  a  gland,  as 
arsenic  by  the  stomach,  or  by  its  being  retained  within  an 
organ  for  a  longer  or  shorter  period,  as  lead  by  the  brain 
and  spinal  cord. 

The  time  required  for  either  the  elimination  or  deposi- 
tion of  a  poison  varies  according  to  the  particular  poison 
taken  and  to  the  state  of  the  system.  Potassium  iodide 
and  turpentine  may  appear  in  the  urine  within  a  few  min- 
utes after  being  swallowed.  Arsenic  may  be  found  in  the 
liver  in  four  hours  and  earlier  after  it  is  taken,  being  usu- 
ally eliminated  from  the  system  within  fifteen  days  if  the 
individual  should  survive  for  that  length  of  time.  Anti- 
mony, on  the  other  hand,  may  be  found  four  months  after 
having  been  taken,  lead  and  copper  over  eight  months.2 

The  phenomena  of  nutrition  would  lead  us  to  suppose 

1  Christison :  Treatise  on  Poisons,  fourth  edition,  Edinburgh,  1885. 

2  Orfila :  Annales  de  Hygiene  publique  et  de  Medecine  legale,  second 
series,  tome  iii.,  Paris,  p.  213. 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.      1  83 

that  it  is  probably  only  that  portion  of  the  poison  flowing 
in  the  capillaries  to  which  its  effects  arc  due.  As  this 
boars  but  a  small  proportion  to  that  found  in  the  stomach, 
which  is  often  in  large  quantity,  it  is  obvious  that  death 
cannot  be  attributed  to  the  latter,  which  must  be  regarded 
as  a  surplus,  a  source  of  supply,  should  the  poison  circu- 
lating through  the  system  be  insufficient  to  produce  its 
characteristic  effects.  The  exact  manner  in  which  death 
is  caused  by  poison  must  be  admitted  not  to  be  as  yet  un- 
derstood, though  the  question  has  given  rise  to  much  dis- 
cussion. The  view  has  been  advanced  that  poisons  act  in 
so  altering  the  composition  of  the  blood  as  to  render  it  unfit 
to  maintain  life.  Even  if  this  could  be  proved,  it  would 
not  be  an  explanation  of  the  modus  operandi  of  poisoning. 
In  the  present  state  of  toxicological  knowledge,  all  that 
can  be  said  is  that  opium,  for  example,  causes  narcotism 
by.  acting  upon  the  brain  ;  prussic  acid,  asthenia  through 
its  effect  upon  the  heart ;  strychnia,  tetanus  by  its  effect 
upon  the  spinal  cord.  As  to  why  these  particular  sub- 
stances act  in  this  peculiar  way,  no  satisfactory  answer  can 
be  given  any  more  than  as  to  why  certain  poisons  are  elim- 
inated with  particular  secretions,  as  mercury  with  the  saliva. 
As  a  general  rule,  the  larger  the  dose  of  the  poison  the 
quicker  the  action,  the  exceptions  being  afforded  by  sub- 
stances like  arsenic,  which,  when  taken  in  an  overdose, 
induce  vomiting,  and  are  therefore  rejected  from  the  sys- 
tem. Certain  poisons  undoubtedly  act  antagonistically 
towards  each  other,  the  effect  of  the  one  poison  being  more 
or  less  neutralized  by  the  other.  Thus,  for  example,  mor- 
phia antagonizes  atropia,  and  atropia  neutralizes  strychnia. 
Indeed,  so  true  is  this  in  the  case  of  the  two  latter  alka- 
loids that  in  strychnia-poisoning  atropia  should  be  admin- 
istered as  an  antidote.     On  the  same  principle,  digitalis 


184  A   MANUAL   OF 

might  be  tried  in  cases  of  aconite-poisoning,  there  being 
an  antagonism  between  these  drugs  also. 

The  power  of  poisons  to  produce  their  characteristic 
effects  is  very  much  diminished  by  their  prolonged  use, 
enormous  amounts  of  laudanum  and  morphia,  for  instance, 
being  tolerated  by  confirmed  opium-eaters,  and  arsenic  by 
arsenic-eaters. 

Sleep,  whether  induced  naturally  or  by  opium,  usually 
diminishes  or  retards  the  action  of  poisons,  especially  of 
the  irritant  kind.  Certain  animal  substances,  which,  when 
introduced  into  the  system,  are  very  poisonous,  often  in- 
deed fatal,  are,  however,  when  swallowed  so  modified  by 
the  digestive  fluids  as  to  be  rendered  innocuous,  as  shown 
by  the  fact  that  persons  are  unaffected  after  sucking 
wounds  made  by  poisoned  arrows,  snake-bites,  etc. 

Disease  modifies  the  action  of  poisons.  Persons  suffering 
with  apoplexy  and  inflammation  of  the  brain  are  very 
susceptible,  for  example,  to  the  action  of  opium.  On  the 
other  hand,  large  quantities  of  opium  are  tolerated  in 
tetanus  and  mania-a-potu.  The  evidences  in  cases  of  al- 
leged poisoning  are  afforded  by  the  symptoms,  the  post- 
mortem appearances,  chemical  analysis,  experiments  upon 
animals,  circumstantial  evidence. 

Evidence  of  Poisoning  derived  from  Symptoms. — In  con- 
sidering the  symptoms  presented  by  a  person  supposed  to 
have  been  poisoned,  it  is  most  important  to  ascertain  whether, 
at  the  time  of  the  attack,  the  person  was  perfectly  well, 
whether  the  symptoms  appeared  shortly  after  the  taking  of 
food  or  drink,  and  whether  any  other  persons  were  affected 
in  a  similar  manner.  The  great  difficulty  experienced  by 
the  medical  examiner  in  determining,  from  the  symptoms 
alone,  whether  a  person  has  been  poisoned,  arises  from 
the  similarity  between  the  symptoms  of  disease  and  those 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      185 

due  to  poison.  Tims,  for  example,  the  symptoms  of  ma- 
lignant cholera,  cholera  morbus,  peritonitis,  ulcer  of  the 
stomach  resemble  very  closely  those  due  to  irritant  poi- 
sons. Indeed,  eases  of  arsenic-poisoning  have  been  mis- 
taken for  attacks  of  cholera  morbus.  On  the  other  band, 
the  effects  of  narcotic  poisons  resemble  in  many  respects 
those  due  to  apoplexy,  inflammation  of  the  brain,  certain 
cardiac  disorders,  etc.  The  above  examples  among  many 
which  might  be  given  serve  to  prove  that  the  symptoms 
alone  in  any  case  would  not  warrant  the  medical  examiner 
in  stating  positively  that  a  person  had  been  poisoned,  nor, 
on  the  other  hand,  in  warranting  him  to  attribute  to  dis- 
ease an  alleged  case  of  poisoning. 

In  addition  to  what  has  already  been  said  as  to  the 
manner  of  making  post-mortem  examinations,  it  is  espe- 
cially important,  in  connection  with  poison  cases,  that  the 
stomach  and  other  viscera  should  be  placed  in  a  perfectly 
clean  glass  jar.  Otherwise  the  defence  on  trial  might 
plausibly  argue  that  the  poison  found  by  the  chemist  was 
derived  from  the  dirt  in  the  jar,  and  not  from  the  viscera 
of  the  person  alleged  to  have  been  poisoned.  Further, 
in  case  the  stomach  or  other  viscera  are  to  be  submitted  to 
a  chemist  for  analysis  of  their  contents,  the  physician  who 
makes  the  post-mortem  examination  should  pack  the  jar 
with  its  contents  securely  in  a  box,  seal  the  latter  up,  and 
label  it.  It  is  desirable,  where  possible,  for  the  medical 
examiner  to  place  the  box  in  the  hands  of  the  chemist 
himself.  Whoever  delivers  it,  however,  should  take  a 
receipt  for  it.  The  neglect  of  such  precautions  on  the 
part  of  the  physician  making  the  autopsy  in  a  poison  case 
may  give  rise,  on  trial,  to  the  objection  that  the  stomach, 
etc.,  in  passing  through  different  hands,  may  have  been 
tampered  with,  and   the   testimony  of  the    chemist  who 


186  A   MANUAL   OP 

fouud  the  poison  may  be  thereby  materially  weakened. 
In  opening  the  stomach  in  poison  cases  it  will  be  found 
most  convenient  to  make  the  incision  along  the  lesser  curv- 
ature; then,  after  collecting  and  measuring  the  contents, 
to  spread  the  stomach  out  upon  a  clean  glass  plate,  the 
inner  or  mucous  surface  being  uppermost;  the  latter  should 
then  be  examined  most  carefully  both  for  lesions  and  the 
remains  of  the  poison. 

Post-mortem  Appearances. — Among  the  post-mortem 
signs  usually  presented  in  poison  cases  may  be  men- 
tioned redness,  softening  of  the  mucous  membrane  of 
the  stomach  and  intestines,  ulceration  and  perforation. 
It  need  scarcely  be  mentioned,  however,  that,  as  the 
same  signs  may  be  due  to  disease,  the  medical  exam- 
iner should  be  cautious  in  attributing  them,  even  in 
suspicious  cases,  to  poison.  Not  unfrequently  remains  of 
poison,  such  as  crystals  of  arsenic,  pieces  of  phosphorus, 
vegetable  leaves,  etc.,  may  be  found  in  the  stomach  and 
intestines.  In  cases  of  poisoning  by  prussic  acid,  opium, 
nicotine,  etc.,  the  odor  of  these  substances  on  opening  the 
body  becomes  very  perceptible.  Occasionally  the  cheeks, 
mouth,  tongue,  and  dress  of  the  deceased  may  be  stained, 
as  in  cases  of  poisoning  by  mineral  acids.  One  of  the 
most  convincing  of  the  evidences  of  poisoning  that  can 
be  adduced  is  the  discovery  of  the  poison.1  In  order  to 
prove  that  death  was  caused  by  poisoning,  the  law,  how- 
ever, does  not  require  that  the  poison  should  be  actually 
discovered,  many  criminals  having  been  convicted  on  other 
evidence,  circumstantial  and  otherwise.  Indeed,  if  the 
discovery  of  the  poison  was  essential  to  conviction,  many 
criminals  would  escape,  as  there  is  no  reliable,  certain  test 

1  "  Tunc  demum  res  certa,  erit,  ubi  venemum  ipsum  reperietur  facile 
agnoscendum  "  (Wharton  and  Stille :  op.  cit.,  vol.  ii.  p.  44). 


MEDICAL  JURISPRUDENCE  and  TOXICOLOGY.     187 

for  many  poisons,  especially  of  the  animal  and  vegetable 
kinds.  On  the  other  hand,  the  mere  finding  of  a  poison 
within  the  stomach  would  not  necessarily  lead  to  convic- 
tion if  the  lesions  usually  produced  by  the  poison  were  not 
present;  and  if  other  proof,  such  as  symptoms,  circum- 
stantial evidence,  etc.,  were  absent.  Indeed,  it  might  be 
argued,  in  such  a  case,  that  the  poison  had  been  introduced 
into  the  stomach  after  death  for  some  malicious  purpose, 
with  the  motive  perhaps  of  exciting  suspicion  and  of  leading 
to  the  conviction  of  some  innocent  person.  The  fact  that 
the  poison  was  found  in  the  liver,  spleen,  etc.  would  be  a 
much  stronger  proof  that  death  was  caused  by  the  poison 
than  the  finding  of  it  in  the  stomach  alone,  as  in  the 
former  case  it  would  be  inferred  that  the  poison  had  been 
absorbed.  It  must  be  remembered,  however,  that  a  poison 
might  be  introduced  into  the  stomach  or  rectum  after 
death,  and  thence  by  osmosis  pass  possibly  all  through  the 
body,  for,  although  the  bony  cranium  and  spinal  column 
would  prevent  osmosis,  nevertheless,  if  the  poison  were  im- 
bibed by  the  nerves,  it  might  possibly  be  transmitted  by 
the  latter  not  only  to  the  cord,  but  even  to  the  brain  itself. 
Chemical  Analysis. — In  making  an  analysis  it  is  import- 
ant that  the  chemist  should  inform  himself  as  to  the  nature 
of  the  symptoms,  as  well  as  of  the  post-mortem  appearances 
presented,  inasmuch  as  these  may  serve,  to  some  extent  at 
least,  to  indicate  the  nature  of  the  poison  taken.  In  every 
case  the  analysis  should  be  made  as  carefully  and  as  thor- 
oughly as  possible.  As  a  matter  of  precaution  only  one 
portion  of  the  suspected  substance  should  be  analyzed  at  a 
time,  the  remaining  portion  being  reserved  in  case  an  acci- 
dent should  happen,  or  there  should  arise  a  necessity  for 
future  investigation.  The  substance  suspected  to  be  poison 
ought  to  respond  to  all  the  tests.     It  is  also  most  import- 


188  A   MANUAL   OP 

ant  that  the  reagents,  previous  to  being  used,  should  have 
been  determined  to  be  pure,  so-called  "  chemically  pure  " 
reagents  often  containing  impurities.  In  many  analyses 
it  is  of  advantage  to  reduce  the  bulk  of  the  liquid  by 
evaporation,  since  the  quantity  of  poison  present  might  be 
so  small  as  not  to  respond  to  the  ordinary  tests.  Not- 
withstanding, however  carefully  the  analysis  may  have 
been  made,  the  chemist  fails  in  many  instances  to  discover 
any  poison.  It  must  be  remembered,  in  connection  with 
failures  to  find  poison  in  those  cases  where  all  the  other 
evidence  concurs  in  showing  that  poison  had  been  taken, 
that  the  latter  may  have  been  vomited  or  have  passed  out 
of  the  system  in  the  feces  and  urine.  The  poison,  fur- 
ther, may  have  been  of  such  a  nature  as  to  be  unrecogniz- 
able by  any  means  at  present  known,  or  to  have  been  de- 
composed in  the  blood  or  tissues  during  life  or  after  death. 
Experiments  on  Animals. — In  those  cases  where  the  poison 
cannot  be  determined  by  either  the  symptoms,  post-mortem 
appearances,  or  chemical  analysis,  there  remains  still  another 
resource — that  of  experimentation  upon  animals.  For  ex- 
ample, in  an  obscure  case  of  strychnia-poisoning,  some  of 
the  suspected  matter,  found  perhaps  in  the  stomach  of  the 
deceased,  might  be  injected  subcutaneously  into  a  frog,  the 
latter  animal,  as  is  well  known,  being  extremely  suscep- 
tible to  the  effects  of  that  alkaloid.1  Criminals  have  been 
convicted  of  giving  digitalis  and  aconite  in  this  way, 
these  poisons  having  been  recognized  through  their  char- 
acteristic effects  produced  upon  animals.  It  is  an  interest- 
ing fact,  in  this  connection,  that  animals  enjoy  an  immunity 
from  being  poisoned  by  certain  plants  which,  when  eaten 
by  man,  usually  prove  fatal ;  and,  further,  that  man  may 

1  Orfila :   Traite  des  Poisons,  troisieme  edition,  tome  premier,  Paris, 
1826,  p.  31. 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.       189 

be  poisoned  by  outing  an  animal  that  has  previously  fed 
upon  such  plants.  Thus,  it  is  well  known  that  the  milk  of 
cattle  browsing  upon  the  herbage  in  certain  parts  of  South 
America,  and  the  meat  of  the  rabbit  which  has  eaten  bel- 
ladonna, will  prove  poisonous  to  human  beings  partaking 
of  them.1 

Circumstantial  Evidence. — Although  the  consideration 
of  the  circumstantial  evidences  of  poisoning  in  a  crim- 
inal case  does  not  constitute  a  part  of  the  duty  of  the 
medical  examiner,  nevertheless  a  knowledge  of  all  the 
circumstances  bearing  upon  the  case  will  be  of  advan- 
tage. Among  such  circumstances  may  be  mentioned  par- 
ticularly :  Whether  the  person  accused  had  any  motive 
for  poisoning  the  deceased.  Was  there  any  evidence 
that  the  accused  had  recently  purchased  the  particular 
poisou  found,  or  that  he  had  had  any  in  his  possession 
for  some  time?  Did  he  give  the  deceased  always  his 
meals?  Was  medical  advice  sought,  and,  if  so,  was  the 
medicine  always  given  by  the  accused  ?  If  any  matters 
were  vomited  during  the  illness  of  the  deceased,  were  they 
submitted  to  the  physician  for  examination,  or  thrown 
away  at  once  and  nothing  whatever  said  about  them? 
Was  the  burial  premature  and  very  quiet  ?  Was  an 
autopsy  objected  to?  It  is  needless  to  say  that,  if  the 
accused  acted  in  such  a  way,  there  would  be  good  reason, 
indeed,  to  suspect  foul  play. 

Character  of  Evidence  of  the  Chemical  Expert. — In 
all  criminal  cases  of  poisoning  the  physician  or  the 
chemist,  or  whoever  makes  the  analysis,  must  be  prepared 
to  answer  at  the  trial  such  questions  as  the  following  : 
Could  the  sickness  or  death  be  ascribed  to  poison,  and,  if 
so,  to  what  particular  poisou  ?     Would  such  a  poison  as 

1  Guy  and  Ferrier  :  op.  cit.,  p.  372 ;  Beck  :  op.  cit.,  vol.  ii.  p.  414. 


190  A    MANUAL   OF 

that  alleged  to  have  been  given  produce  death  if  adminis- 
tered in  sufficient  quantity  ?  At  what  period  was  the 
poison  given?  Could  such  a  poison  disappear  so  entirely 
from  the  system  as  to  leave  no  trace  ?  Might  the  poison 
discovered  in  the  body  of  the  deceased  have  been  derived 
from  some  other  source  than  that  which  was  claimed  to 
show  that  it  had  been  criminally  administered?1  The  an- 
swers to  be  given  by  the  medical  witness  to  such  questions 
will  largely  depend  upon  what  particular  kind  of  poison 
may  have  been  given,  as  will  become  more  apparent  when 
the  different  kinds  of  poisons  will  have  been  considered. 

The  effects  of  poison  are  simulated  occasionally;  the 
imposture  will  be  discovered,  however,  in  time  at  least,  if 
not  by  other  means.  Insane  people  are  frequently  deluded 
with  the  idea  that  attempts  are  being  made  to  poison  them, 
or  that  they  have  been  poisoned. 

1  Tardieu,  A.:  Etude  medico-legale  et  clinique  sur  I' Empoisonnement, 
Paris,  1867. 


MEDICAL    JURISPRUDENCE    AND    TOXICOLOGY.       1  !)  I 


CHAPTER  II. 

Classification  of  Poisons  —  Irritant  Poisons  —  Poisoning  by  Mineral 
Acids,  by  Alkalies  and  their  Salts,  Noxious  Gases — Poisoning  by 
Phosphorus,  Arsenic,  Antimony,  Mercury,  Lead,  popper,  etc — Poi- 
soning by  Oxalic  Acid,  Carbolic  Acid,  etc. — Poisoning  by  Decom- 
posed Food,  Ptomaines,  Neurotic  Poisons — Poisoning  by  Opium, 
Alcohol,  Ether,  Chloroform,  Chloral,  Nux  Vomica,  Strychnia,  Bel- 
ladonna, Stramonium,  Tobacco,  Lobelia,  Hydrocyanic  Acid. 

Systematic  writers  upon  the  subject  of  Toxicology  vary 
very  much  in  the  manner  in  which  they  classify  poisons. 
In  this  manual,  however,  poisons  will  be  regarded  as  con- 
sisting of  only  two  kinds :  Irritants  and  Neurotics.1 


Poisons 


Irritants 


f  Mineral  Acids,  Alkalies,  Phosphorus,  Bro- 
mine, Iodine,  Arsenic,  Antimony,  Mer- 
cury, Lead,  Copper,  Tin,  Bismuth,  Car- 
bolic Acid,  Trichiniasis,  Ptomaines. 

Opium,  Alcohol,  Anaesthetics, 
Chloral  Hydrate,  Carbon  Ox- 
ide, Carbon  Dioxide. 


r  Cerebral 
Spinal     . 


Neurotics 


Cerebro- 
spin 


,  -J  Depressants  -J 


.  Strychnos  Nux  Vomica. 

{Stramonium,  Hy- 
oscyamus,  Atro- 
pa  Belladonna. 

( Nicotiana  Taba- 
cum,  Lobelia, 
Aconitum. 

Digitalis,  Cocculus 
Indicus,  Acidum 
Hyd  rocy  an  i  cu  m . 

Irritant  poisons  include  substances  which,  when  swal- 
lowed, give  rise  to  an  acrid,  burning  taste,  followed  by 
nausea,  vomiting,  cramps  in  stomach,  purging,  the  matters 
1  Taylor :  op.  cit.,  p.  78. 


[Asthenics 


192  A    MANUAL    OF 

vomited  and  purged  being  often  mixed  with  blood,  these 
symptoms  being  due  to  inflammation  of  the  mucous  mem- 
brane of  the  alimentary  canal,  terminating  not  unfrequently 
in  ulcer,  perforation,  and  gangrene.  They  may  possess 
simple  irritant  properties  or  specific  ones,  and  are  derived 
from  the  mineral,  vegetable,  and  animal  kingdoms.  The 
simple  irritant  poisons  include  such  substances  as  the  min- 
eral acids  and  alkalies.  Among  those  possessing  specific 
properties  may  be  mentioned  phosphorus,  arsenic,  anti- 
mony, mercury,  oxalic  and  carbolic  acids,  cantharides, 
poisoned  meat,  fish,  etc. 

Neurotic  poisons  include  such  substances  as  have  a  spe- 
cific action  upon  the  brain  and  spinal  cord,  causing  head- 
ache, giddiness,  drowsiness,  stupor,  delirium,  coma,  con- 
vulsions, paralysis.  They  are  derived  from  the  vegetable 
kingdom  and  include  substances  like  opium,  chloral, 
strychnia,  atropia,  Calabar  bean,  prussic  acid,  etc. 

Irritant  Poisons. — Poisoning  by  Mineral  Acids. — As  a 
general  rule,  most  cases  of  poisoning  due  to  mineral  acids 
are  accidental  in  character,  suicide  being  only  occasionally 
committed  by  such  means,  and  homicides  but  rarely.  As 
the  symptoms,  post-mortem  appearances,  general  treat- 
ment, in  poisoning  by  the  different  mineral  acids,  are  very 
much  the  same,  they  may  be  conveniently  considered  to- 
gether. The  symptoms  in  cases  of  poisoning  of  this  kind, 
which  depend  more  on  the  degree  of  concentration  than  on 
mere  quantity,  are  a  burning  sensation  in  the  mouth,  fol- 
lowed by  violent  pain  in  the  stomach,  vomiting  of  dark- 
colored  coifee-grounds-like  matters  containing  blood,  and 
occasionally  portions  of  mucous  membrane.  In  all  cases 
of  poisoning  by  mineral  acids,  magnesia,  chalk,  plaster  oif 
the  walls  (if  nothing  better),  soap-suds,  oil,  milk,  mucilagi- 
nous drinks,  flaxseed  tea,  or  barley-water  may  be  adminis- 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY!       L93 

tered.  If  undiluted  acid  has  been  swallowed,  however, 
there  is  but  little  hope  that  the  remedies  jnsi  mentioned 
or  any  others  will  do  much  good.  The  smallest  recorded 
quantity  of  sulphuric  acid  known  to  have  destroyed  life 
was  one  drachm,  the  shortest  known  period  at  which  death 
has  taken  place  being  within  two  hours.1 

On  post-mortem  examination  stains  and  corrosions  are 
found  on  all  parts  with  which  the  acid  has  come  in  con- 
tact. The  stomach  is  filled  with  black,  yellow,  or  brown 
fluid,  perhaps  distended  with  gas,  its  mucous  membrane 
charred  or  inflamed,  perforation  not  being  uncommon  in 
cases  of  sulphuric  acid  poisoning.  The  skin  is  stained 
black  or  dark  brown  by  sulphuric  acid,  yellow  by  nitric 
acid,  white  by  hydrochloric  acid.  In  cases  of  sulphuric 
acid  poisoning  the  contents  of  the  stomach  should  be  fil- 
tered and  then  treated  with  any  soluble  salt  of  barium. 
The  dense  white  precipitate  produced,  insoluble  in  acid 
and  alkalies,  with  charcoal  and  blowpipe  will  yield  barium 
sulphide,  which  in  turn  with  a  mineral  acid  gives  sul- 
phuretted hydrogen,  recognizable  by  the  black  stain  it 
gives  to  filtering  paper  dipped  into  a  solution  of  lead  salt. 

The  smallest  quantity  of  nitric  acid  recorded  as  having 
destroyed  life  was  two  drachms,  death  having  taken  place 
within  two  hours.2 

In  cases  of  poisoning  by  nitric  acid,  the  matters  ob- 
tained from  the  stomach  should  be  first  filtered.  The 
clear  acid  liquid  so  obtained  should  then  be  heated  and  a 
weak  solution  of  potassium  carbonate  added.  Paper  dipped 
into  a  concentrated  solution  of  the  latter  will  afterwards 
burn  with  deflagration.  A  few  drops  of  the  filtered  solu- 
tion  evaporated   to   dryness  on    a   glass  slide  will  give 

1  Christison  :  op.  cit.,  p.  162. 

2  Wharton  and  Stille  :  op.  cit.,  vol.  ii.  p.  179. 
13 


194  A    MANUAL    OF 

crystals  of  potassium  nitrate.  On  making  a  solution  of 
these  crystals  and  adding  a  crystal  of  ferrous  sulphate 
with  a  drop  or  two  of  strong  sulphuric  acid,  the  green 
color  of  the  crystal  will  change  to  reddish-brown,  due  to 
the  formation  of  ferric  sulphate.  Morphina  and  brucina 
will  serve  as  tests  for  concentrated  nitric  acid,  being  turned 
red  by  the  acid.  Ruddy  brown  fumes  are  also  given  off 
when  nitric  acid  is  poured  on  copper.  In  order  to  extract 
hydrochloric  acid  from  the  stomach  it  is  only  necessary 
to  add  silver  nitrate  to  the  filtered  contents,  the  white  pre- 
cipitate silver  chloride  formed  being  readily  recognizable 
by  being  soluble  in  liquor  ammonia?  and  precipitable  by 
nitric  acid,  blackening  upon  exposure  to  light  and  melting 
into  a  mass  known  as  horn  silver  when  heated.  The  fact 
that  hydrochloric  acid  dissolves  gold  leaf  in  the  presence 
of  nitric  acid  affords  a  convenient  test  for  the  concentrated 
acid,  as  also  the  white  fumes  given  off  with  vapor  of  am- 
monia. The  smallest  quantity  of  hydrochloric  acid  known 
to  have  destroyed  life  is  half  an  ounce,  the  shortest  period 
within  which  death  took  place  being  two  hours.1 

Poisoning  by  Alkalies. — The  alkalies,  potassa,  soda,  and 
ammonia,  are  rarely  used  for  homicidal  purposes.  As 
potassa  and  soda  are,  however,  extensively  used  in  the 
arts,  in  the  manufacture  of  glass  and  soap,  under  the 
name  of  pot-  and  pearl-ashes,  soda  ashes  and  soap  lees, 
and  ammonia  in  the  form  of  aqua  ammonia?  for  various 
household  purposes,  illnesses  and  occasionally  death  have 
occurred  as  the  result  of  taking  them  accidentally. 

The  symptoms  of  poisoning  by  the  alkalies  are  an  acrid, 
nauseating  taste,  followed  by  a  burning  heat  in  the  throat 
and  stomach,  violent  abdominal  pains,  vomiting  and  purg- 
ing. Ammonia,  being  more  irritating  than  potassa  or  soda, 
affects  the  respiratory  organs  especially,  inducing  a  chok- 
1  Taylor  :  op.  cit.,  p.  102. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      195 

ing  sensation.  In  cases  of  poisoning  by  any  of  the  alka- 
lies, vinegar  and  water,  lime  or  orange  juice,  oil,  which 
forms  -with  alkali  soap,  should  be  given,  opium  being 
administered  to  relieve  pain.  The  quantity  of  potassa  or 
soda  or  ammonia  that  may  prove  fatal  is  variable,  death 
having  been  caused  by  half  an  ounce  of  caustic  potassa 
and  by  forty  grains  in  solution  and  by  two  drachms  of 
ammonia.1  Persons  have,  however,  recovered  after  swal- 
lowing over  an  ounce  of  ammonia.  Death  may  take  place 
from  poisoning  by  alkalies  within  a  few  hours  or  days,  or 
may  be  protracted  several  months.  In  fatal  cases,  on 
post-mortem  examination,  the  mucous  membrane  of  the 
mouth,  throat,  and  gullet  will  be  found  corroded,  often 
blackened,  and  even  completely  destroyed,  the  larynx  and 
bronchi  being  particularly  inflamed  and  softened  in  cases 
of  ammonia-poisoning. 

In  examining  the  contents  of  the  stomach,  as  a  general 
rule,  the  organic  matters  can  be  removed  by  evaporation 
and  subsequent  heating ;  the  ash  remaining  being  digested 
with  distilled  water  and  filtered,  the  potassa  or  soda  will  be 
found  in  solution  as  a  carbonate.  Potassium  compounds 
give  a  violet  color,  sodium  compounds  a  yellow  color  to 
the  smokeless  flame  of  spirit  or  gas.  The  presence  of  these 
alkalies  can  be  readily  recognized  also  by  means  of  the 
spectroscope.  Potassium  can  also  be  tested  for  by  using 
tetrachloride  of  platinum,  which  throws  down  a  yellow 
granular  precipitate  consisting  of  potassio-platino  chloride. 
In  making  use  of  this  test,  the  absence  of  ammonia  must 
be  insured.  Soda  may  be  recognized  from  the  white  pre- 
cipitate thrown  down  by  the  addition  of  potassium  anti- 
moniate.  Ammonia  may  be  extracted  from  the  stomach 
by  distilling  about  one-fourth  of  the  liquid,  the  vapor 
being  carried  through  a  bent  tube  into  a  well-cooled  re- 
1  Woodman  and  Tidy  :  op.  tit.,  pp.  92,  105. 


196  A    MANUAL    OF 

ceiver  containing  a  small  quantity  of  water  acidulated  with 
hydrochloric  acid.  If  no  ammonia  should  be  given  off, 
the  contents  of  the  retort  should  be  treated  with  alcohol 
filtered  and  redistilled  with  lime  hydrate,  by  which  free 
ammonia,  perceptible  from  its  odor,  will  be  obtained.  As 
ammonia  is  one  of  the  products  of  putrefaction,  if  the  con- 
tents of  the  stomach  should  be  found  in  that  condition  it 
will  be  useless  to  attempt  to  make  an  analysis.  A  con- 
venient test  for  ammonia  is -platinum  tetrachloride,  which 
gives  a  yellow  precipitate. 

The  alkaline  salts  and  earth,  potassium  nitrate  or  salt- 
petre, used  in  medicine  and  in  the  manufacture  of  gun- 
powder, potassium  bitartrate  or  cream  of  tartar,  potassium 
sulphate,  chlorinated  soda  and  potash  or  bleaching  salts, 
magnesium  sulphate  or  Epsom  salts,  the  salts  of  barium, 
strontium,  calcium,  and  even  common  salt,  have  all  proved 
fatal  when  taken  in  overdoses  or  in  large  quantities.  As 
cases  of  poisoning  from  such  substances  were  not  homi- 
cidal in  character,  but  resulted  from  accident,  it  will  not 
be  necessary  to  describe  the  symptoms,  post-mortem  ap- 
pearances, etc.  It  may  be  mentioned,  however,  that  the 
proper  treatment  in  such  cases,  generally  speaking,  is  to 
evacuate  the  poison  by  emetics  and  mucilaginous  drinks, 
and  the  administration  of  antiphlogistic  remedies. 

Poisoning  by  Noxious  Gases. — Among  the  irritant 
poisons  may  also  be  included  nitrous  acid,  sulphurous 
acid,  hydrochloric  acid,  and  chlorine  gases.  The  dele- 
terious effects  of  the  fumes  of  such  gases  are  well  known, 
causing  irritation  and  inflammation  of  the  throat,  eyes, 
and  air-passages,  inducing  in  some  cases  even  spasm  of 
the  glottis.  The  production  of  these  gases  is  incidental 
to  various  manufacturing  processes,  nitrous  acid  gas  being 
generated  upon  a  large  scale  in  water-gilding  and  brass- 


MEDICAL  JURISPRUDENCE   AM)  TOXICOLOGY.      107 

button-making,  sulphurous  add  gas  in  bakers'  ovens, 
hydrochloric  acid  gas  in  potteries.  As  such  cases  of  poi- 
soning arc  often  of  a  chronic  rather  than  acute  character, 
and  but  rarely  become  the  subjed  of  medico-legal  investi- 
gation, it  will  not  be  necessary  to  dwell  further  upon  the 
noxious  effects  of  these  gases. 

Poisoning  by  Phosphorus. — With  the  description  of  phos- 
phorus poisoning  wc  begin  the  consideration  of  that  class  of 
irritant  poisons  which  not  only  act  upon  the  mucous  mem- 
brane of  the  alimentary  canal,  or  the  part  of  the  body  they 
come  directly  in  contact  with,  but  also  upon  remote  parts 
of  the  system — the  nervous  centres  being  often  especially 
affected.  It  is  true  that  some  of  the  alkaline  and  earthy  salts 
just  mentioned  possess  similar  properties  to  some  extent ; 
but,  as  poisoning  is  rarely  caused  in  this  way,  their  specific 
properties  were  not  referred  to.  Phosphorus  is  but  seldom 
used  for  homicidal  and  not  very  frequently  for  suicidal 
purposes.  Most  cases  of  poisoning  of  this  kind  are  acci- 
dental in  character,  caused  by  swallowing  the  phosphorus 
paste  used  for  destroying  vermin,  or  the  tops  of  lucifer 
matches.  Poisoning  by  phosphorus  is  much  less  common 
than  formerly,  the  red  or  amorphous  form,  which  is  not 
poisonous,  being  so  much  more  used  than  the  yellow 
variety.  In  acute  cases  the  symptoms  vary  at  the  com- 
mencement, sometimes  setting  in  rapidly,  at  others  being 
protracted.  As  a  general  rule,  within  from  one  to  two 
hours,  a  peculiar,  disagreeable  taste  is  experienced,  accom- 
panied with  intense  warmth  in  the  stomach  and  bowels, 
which  gradually  turns  into  a  violent,  burning  pain.  Eruc- 
tations having  a  garlicky  odor,  followed  by  nausea,  vomit- 
ing and  purging  are  not  infrequent.  The  matters  vomited 
are  usually  dark-colored,  and  have  the  garlicky  odor  of 
phosphorus.     The  pupils  are  dilated,  the  abdomen  dis- 


198  A   MANUAL   OF 

tended,  the  extremities  cold,  the  pulse  weak,  the  thirst 
intense.  Between  the  third  and  fifth  day,  if  the  case  is  a 
protracted  one,  jaundice  appears,  often  accompanied  with 
retention  of  urine  and  delirium,  the  patient  dying  possibly 
in  convulsions  or  comatose.  Recovery  is  very  rare.  The 
most  constant  symptoms  in  chronic  phosphorus  poisoning 
are  weakness  and  fatigue,  pains  in  the  abdomen,  with 
diarrhoea,  intermittent  toothache,  carious  teeth,  with  gums 
swollen  and  distended  with  pus  ;  the  complexion  sallow, 
eruption  upon  the  skin ;  falling  off  of  the  hair,  increase  of 
phosphates  in  the  urine. 

There  is  no  chemical  antidote  for  phosphorus.  The 
poison  should  be  removed  as  soon  as  possible.  If  the 
patient  is  seen  shortly  after  taking  the  poison,  the  stomach- 
pump  should  be  used ;  otherwise,  an  emetic  of  sulphate  of 
zinc  or  sulphate  of  copper  should  be  administered,  the 
latter  being  given  in  three-grain  doses,  well  diluted,  at  in- 
tervals. Magnesia  or  chalk,  in  gruel,  should  be  given. 
If  the  poison  has  had  time  to  reach  the  intestines,  purging 
should  be  tried  ;  on  no  account  should  oil  be  given,  as  the 
phosphorus  would  be  dissolved,  and  its  absorption  greatly 
promoted.  It  is  most  important,  as  a  precautionary 
measure,  that  those  engaged  in  phosphorus  manufactories 
should  be  extremely  cleanly  in  their  habits,  changiug  their 
clothes  after  work,  washing  their  faces  and  hands,  and 
rinsing  their  mouths  with  some  slightly  alkaline  wash. 
Saucers  filled  with  turpentine  should  be  placed  about  the 
factory,  the  fumes  appearing  to  exert  a  protective  effect. 
The  smallest  quantity  of  phosphorus  known  to  have  de- 
stroyed life  was  one-and-a-half  grains  in  a  man,  one-eighth  of 
a  grain  in  a  woman.  The  one-fiftieth  of  a  grain  has,  how- 
ever, killed  a  child.1  Death  in  cases  of  acute  phosphorus- 
poisoning  usually  takes  place  within  a  period  of  from  three 
1  Woodman  and  Tidy :  op.  cit.,  p.  71. 


MEDICAL  JURISPRUDENCE   AND  TOXICOLOGY.      199 

to  six  days.  In  one  case  recorded  death  occurred  in  half 
an  hour.  Chronic  cases  may,  however,  last  for  mouths  or 
even  for  years. 

On  post-mortem  examination  the  mucous  membrane  of 
the  alimentary  canal  is  usually  found  inflamed,  softened, 
and  discolored.  In  chronic  cases  the  most  important 
change  observed  is  the  fatty  condition  of  the  liver,  kid- 
neys, heart,  muscles,  etc.,  the  fat  being  probably  derived 
from  the  albumen  of  the  tissues.  The  best  way  of  extract- 
ing phosphorus  from  the  stomach  is  that  of  Mitscherlich. 
This  method  consists  in  distilling  the  suspected  fluid  in 
the  dark  with  a  small  quantity  of  dilute  sulphuric  acid, 
the  object  of  the  latter  being  to  neutralize  the  ammonia 
developed  during  putrefaction.  The  vapors  are  made  to 
pass  through  a  tube  kept  cool  by  running  water  into  a 
receiver,  a  flash  of  light  appearing  every  time  that  the 
phosphorus  vapor  condenses  in  the  tube.  This  method 
is  so  delicate  that  one  part  of  phosphorus  may  be  detected 
by  it  in  one  hundred  thousand  of  substance. 

Bromine  and  iodine,  like  phosphorus,  are  irritant  poisons, 
possessing  specific  properties  as  well.  Bromine  has  been 
used  to  commit  suicide,  and  iodine  in  over-doses  has  caused 
death  accidentally.  The  symptoms  of  poisoning  by  bromine 
are  spasmodic  action  of  the  muscles  of  the  larynx  and  phar- 
ynx, with  great  difficulty  in  breathing,  followed  by  burn- 
ing pain  in  the  stomach.  An  ounce  of  bromine  has  caused 
death  in  seven  hours  and  a  half.  Iodine  in  large  doses 
causes  a  burning  heat  in  the  throat,  pain  in  the  abdomen, 
vomiting,  purging.  In  such  cases  emetics  should  be  ad- 
ministered. The  post-mortem  appearances  presented  are 
those  of  an  irritant  poison.  Fatal  results  have  followed 
from  the  taking  of  twenty  grains  of  iodine.  Death  occurs 
usually  within  thirty  hours  after  the  taking  of  the  poison. 


200  A   MANUAL   OF 

It  may  be  mentioned  that  caution  should  be  exercised  by 
the  physician  in  prescribing  iodide  of  potassium,  as  some 
persons  are  very  susceptible  to  its  influence.  In  such  cases, 
headache,  abdominal  pain,  thirst,  inflammation  of  the  nos- 
trils and  eyes,  salivation,  pustular  eruption  follow  its  ad- 
ministration even  when  given  in  small  doses. 

Poisoning  by  Arsenic. — Arsenic  is  found  in  nature  in  the 
metallic  form,  or  in  combination  with  other  metals,  such  as 
zinc,  copper,  iron,  and  with  sulphur  in  the  form  of  orpi- 
ment  and  realgar.  Arsenic  is  extensively  used  in  the  arts, 
in  the  manufacture  of  enamel,  glass,  composition  candles, 
vermin-killers,  fly-powders  ;  ship-builders  protect  their  tim- 
ber from  worms,  farmers  preserve  their  grain,  grooms  im- 
prove the  coats  of  horses,  and  women  their  skin,  by  arsenic.1 
Arsenic  is  so  readily  obtained  and  so  easily  administered, 
and  is  so  easily  suspended  in  tea,  coffee,  milk,  and  soup, 
etc.,  that  it  is  of  all  poisons  the  most  frequently  used  for 
homicidal  and  suicidal  purposes.  Of  the  various  prepara- 
tions of  arsenic,  the  important  ones,  medico-legally,  are  the 
white  oxide  commonly  known  as  arsenious  acid,  the  yellow 
sulphide  or  orpiment,  the  green  arsenite  of  copper  or 
Scheele's  green,  the  liquor  potassse  arsenitis  or  Fowler's 
solution.  In  whatever  form  taken,  though,  whether  solid, 
liquid,  or  gaseous,  or  howsoever  applied,  either  as  a  wash, 
an  ointment,  or  a  plaster,  arsenic  acts  as  a  poison. 

Arsenious  oxide,  or  white  arsenic,  the  form  of  arsenic 
most  commonly,  made  use  of  for  poisoning  purposes,  oc- 
curs in  commerce  as  a  heavy  white,  opaque,  or  translucent 
powder,  or  in  masses.  It  is  nearly  tasteless,  and  but 
slightly  soluble  in  cold  water,  only  one-half  of  a  grain 
being  dissolved  by  an  ounce  of  water;  the  solubility 
is  increased  by  hot  water,  alkali,  but  diminished  by 
1  Guy  and  Ferrier :  op.  cit.,  p.  436  ;  Tardieu  :  op.  cit.,  p.  323. 


MED1CAJ;   .IIJKIsritUhKNCK    AND   TOXICOLOGY.      2<>| 

organic  matter.  As  a  general  rule,  the  symptoms  of 
arsenical  poisoning  develop  gradually,  being  usually  de- 
layed for  from  half  an  hour  to  an  hour,  or  even  Longer. 

In  certain  cases,  especially  when  a  large  dose  has  been 
taken,  poisonous  symptoms  may  appear  almost  immedi- 
ately. The  countenance  expresses  depression  and  great  suf- 
fering. A  burning  pain  is  experienced  in  the  pit  of  the 
stomach,  which  is  increased  by  pressure;  vomiting  is  in- 
variably present,  the  matters  vomited  consisting  of  a  white 
gum-like  substance  or  of  a  brown  liquid  mixed  with  bile 
or  blood.  Diarrhoea  is  usually  present,  accompanied  with 
pains  at  the  anus  ;  severe  cramps  are  felt  in  the  legs.  The 
throat  is  hot  and  constricted,  the  tongue  furred,  and  thirst 
is  intense.  The  skin  is  hot  and  dry,  the  head  aches,  the 
pulse  is  rapid  and  small.  The  conjunctivas  are  reddened, 
the  eyes  smart,  and  are  suffused,  and  light  is  dreaded. 
Though  there  are  usuallv  extreme  restlessuess  and  nervous 
twitchings,  the  mind,  as  a  general  rule,  is  clear.  Death 
may  occur  with  convulsions  of  an  epileptiform  character, 
or  may  resemble,  as  already  mentioned,  that  of  cholera 
morbus.  In  some  cases  death  takes  place  very  quickly,  as 
if  due  to  shock.  The  symptoms  in  chronic  cases  of  arsenic 
poisoning,  as,  for  example,  where  workmen  have  been  ex- 
posed to  the  vapors  of  arsenic,  are  much  less  pronounced 
than  in  acute  ones.  The  eyes  are  inflamed  and  watery  ; 
headache,  giddiness,  vomiting,  diarrhoea  may  be  present ; 
the  skin  is  affected  with  an  eczema ;  there  may  be  some 
local  paralysis ;  salivation  and  even  mania  have  been 
noticed. 

In  cases  of  arsenical  poisoning,  if  the  patient  is  seen 
soon  after  taking  the  poison,  the  stomach-pump  should  be 
used.  If  any  length  of  time  has  elapsed,  however,  hot 
milk  and  water  and  emetics  of  sulphate  of  zinc  and  mus- 


202  A   MANUAL   OP 

tard  should  be  given.  If  there  has  been  much  vomiting, 
eggs  and  milk  and  magnesia,  with  sugar  in  milk,  should 
be  administered,  the  latter  forming  an  insoluble  compound 
with  arsenious  oxide.  Stimulants  should  be  given  in  a 
state  of  collapse,  and  anodynes  for  nervousness.  The  anti- 
dote in  most  repute  in  cases  of  arsenical  poisoning  is  the 
hydrated  sesquioxide  of  iron,  by  which  the  arsenic  is  con- 
verted into  the  insoluble  arseniate  of  iron.  It  can  be 
freshly  and  quickly  prepared  by  diluting  the  tincture  of  the 
chloride  of  iron,  adding  ammonia  in  excess,  collecting  the 
precipitate  on  filtering  paper,  and  carefully  washing  and 
administering  at  once  when  moist,  The  hydrated  sesqui- 
oxide of  iron  so  prepared  should  be  given  in  large  doses 
and  frequently,  followed  later  by  a  dose  of  castor  oil. 
Freshly-precipitated  hydrated  peroxide  of  magnesium  has 
also  been  proved  serviceable  as  an  antidote.  Nitrate  of 
potassium  may  be  given  also  in  repeated  doses  in  order  to 
promote  the  elimination  of  the  poison  by  the  kidneys.  It 
appears  that,  however  large  the  amount  of  arsenic  taken, 
no  more  than  two  grains  need  be  absorbed  to  cause  death. 
At  all  events,  that  amount  has  proved  fatal,  though  there 
have  been  recoveries  after  much  larger  doses.  Death 
usually  takes  place  within  twenty-four  hours,  though  it 
may  occur  within  twenty  minutes  or  be  delayed  ten  to 
sixteen  days  after  taking  the  poison. 

On  post-mortem  examination,  the  mucous  membrane  of 
the  stomach  will  be  usually  found  highly  inflamed,  present- 
ing, in  some  cases,  a  uniform  deep  red  color;  in  others 
only  red  patches.  In  some  cases  the  mucous  membrane  is 
thickened,  in  others  softened  and  easily  separated.  Ulcera- 
tion of  the  stomach  but  rarely  takes  place.  However  intro- 
duced, arsenic  appears  to  have  some  specific  effect  upon  the 
stomach.     Not  unfrequently  the  small  intestine,  the  cse- 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      203 

cum,  and  the  rectum  arc  inflamed  as  well  as  the  stomach. 
It  must  be  mentioned;  however,  that  in  some  cases  of 
arsenic  poisoning  there  is  an  entire  absence  of  any  signs  oi 
inflammation,  even  though  there  had  been  symptoms  of 
inflammation  during  life. 

Arsenic  is  not  a  cumulative  poison,  being  only  tempo- 
rarily deposited  in  the  liver  and  other  organs,  and  rapidly 
eliminated  in  the  urine  and  other  secretions;  accordingly, 
no  trace  of  it  is  likely  to  be  found  after  death,  should  the 
person  have  survived  two  or  three  weeks  after  taking  the 
poison.  On  the  other  hand,  arsenic,  as  is  well  known, 
being  a  powerful  antiseptic,  the  bodies  of  persons  poisoned 
by  this  means  may  be  so  well  preserved  as  to  admit  of  the 
detection  of  the  poison  months  aud  even  years  after  burial. 
Under  such  circumstances  the  absence  of  cadaveric  odor  is 
noticeable,  and  there  will  be  frequently  observed  numerous 
yellow  patches  on  the  abdominal  viscera,  due  to  the  forma- 
tion of  yellow  sulphide  of  arsenic  through  the  action  of 
sulphuretted  hydrogen  upon  arsenious  oxide.  In  examin- 
ing the  contents  of  the  stomach,  the  examiner  should  first 
carefully  look  for  solid  particles  of  arsenious  oxide  in  the 
walls  of  the  stomach  itself,  as  well  as  among  its  contents. 
The  stomach  should  then  be  cut  up  into  small  pieces  with 
a  perfectly  clean  pair  of  scissors,  and,  together  with  its 
contents,  placed  in  a  clean  porcelain  evaporating  dish. 
Distilled  water,  with  one-sixth  its  bulk  of  pure  hydro- 
chloric acid,  should  be  added,  and  the  whole  gently  boiled 
for  about  an  hour,  by  which  time  most  of  the  solid  por- 
tions of  the  mixture  will  be  disintegrated.  After  cooling, 
the  mixture  should  be  filtered,  the  filtrate  being  after- 
wards concentrated  over  a  water-bath.  In  order  to  ex- 
tract arsenic  from  the  liver,  spleen,  or  other  organs,  the 
tissues   should  be   very  finely  cut  up,  and,  after  being 


204  A   MANUAL   OF 

treated  with  distilled  water  and  hydrochloric  acid,  must 
then  be  filtered. 

The  different  tests  for  arsenious  oxide  may  be  regarded 
as  being  of  three  kinds — solid,  liquid,  and  what  may  be 
called  special  tests.  Of  the  solid  tests  the  three  following 
will  be  found  convenient  and  easy  of  application  :  The 
first  test  consists  in  heating  upon  charcoal  the  suspected 
substance ;  if  the  latter  be  arsenious  oxide,  the  odor  of 
garlic  will  become  very  perceptible.  The  second  test  is  to 
slowly  heat  the  substance  in  a  narrow  glass  tube  until  it 
sublimes;  if  arsenious  oxide  be  present,  there  will  be  formed 
on  the  cool  part  of  the  tube  a  white  ring  of  octahedral  crys- 
tals (Fig.  41),  which  can  be  seen  by  a  good  magnifier.  It  is 
true  that  calomel  and  corrosive  sublimate  will  produce  white 
rings  under  the  same  circumstances,  but  they  will  not  con- 
sist of  octahedral  crystals.  The  third  test  is  to  heat  the  sus- 
pected substance  in  a  reduction-tube  (Fig.  42)  about  three 
inches  long  and  an  eighth  of  an  inch  in  diameter  with  dry 
sodium  carbonate  and  charcoal,  the  flux  being  in  the  pro- 
portion of  about  four  to  one  of  the  substance  examined 
and  intimately  mixed  with  it.  If  arsenious  oxide  be  pres- 
ent, it  will  be  reduced,  metallic  arsenic  being  condensed 
as  a  brilliant  steel-gray  ring  upon  the  upper  part  of 
the  tube.  That  the  ring  so  formed  does  consist  of  arsenic 
is  still  further  shown  by  the  fact  that  it  is  entirely  soluble 
in  sodium  hypochlorite. 

The  liquid  tests  are  the  ammonio-sulphate  of  copper, 
the  ammonio-nitrate  of  silver  and  sulphuretted  hydrogen. 
Ammonio-sulphate  of  copper,  when  added  to  a  solution  of 
arsenious  oxide,  throws  down  a  light  green  arsenite  of  cop- 
per, the  precipitate  being  soluble  in  ammonia  and  free 
acids.  The  characteristic  color  does  not  appear  immedi- 
ately if  the  arsenic  is  in  very  small  quantities.     The  am- 


MEDICAL  JURISPRUDENCE   AND   TOXICOLOGY.     205 


monio-sulphate  of  copper,  when   used  for  this   purpose, 
should  be  freshly  prepared  by  adding  to  a  somewhat  dilute 


Fig.  41. 


Crystals  of  arsenious  acid  by 
sublimation,  magnified  30  diam- 
eters. 

Fig.  43. 


Deposit  obtained  by  Marsh's 
apparatus  :  a,  metal ;  b,  mixed 
deposit ;  c,  arsenious  acid. 


Fio.  42. 


Ordinary  reduction- 
tube,  with  two  subli- 
mates ;  the  upper, 
brownish-black ;  the 
lower,  the  pure  metal 
in  an  annular  deposit. 


solution  of  sulphate  of  copper  just  enough  liquor  ammo- 
nia? to  throw  down  a  pale  blue  precipitate.  Ammonio- 
nitrate  of  silver  gives  to  a  solution  of  arsenious  oxide  a 
canary  yellow  precipitate  of  arsenite  of  silver  soluble  in 
an  excess  of  ammonia.  The  reagent  can  be  freshly  pre- 
pared by  adding  just  enough  liquor  ammonia?  to  a  solution 
of  nitrate  of  silver  to  precipitate  the  brown  oxide  of  sil- 


206  A   MANUAL   OP 

ver.  It  should  be  mentioned,  however,  that  as  various 
organic  matters  which  might  be  present  in  the  contents  of 
the  stomach  will  produce  similar  colors  with  both  copper 
and  silver,  the  precipitates  of  arsenite  of  copper  and  silver 
obtained  by  the  liquid  tests  should  be  submitted  to  further 
tests,  such  as  that  by  the  reduction  method  just  described. 
The  sulphuretted  hydrogen  test  consists  in  passing  washed 
sulphuretted  hydrogen  gas  through  the  solution  of  the 
suspected  substance  slightly  acidified  with  hydrochloric 
acid.  If  arsenious  oxide  be  present,  there  will  be  precipi- 
tated the  yellow  tersulphide  of  arsenic,  soluble  in  alkalies 
but  insoluble  in  acids.  In  dilute  solutions  the  excess  of 
gas  may  have  to  be  driven  off  before  the  precipitate  is  sep- 
arated. The  sulphide  of  arsenic  so  obtained  should  still 
further  be  tested  by  subliming  it  with  a  reducing  agent. 
It  should  be  mentioned,  in  connection  with  this  test,  that 
somewhat  similar  precipitates  are  yielded  by  cadmium,  tin, 
and  selenium  in  the  presence  of  sulphuretted  hydrogen. 
For  all  practical  purposes  the  cadmium  sulphide  need  only 
be  considered  in  this  respect,  and  it  should  not  even  prove 
a  source  of  fallacy ;  it  is  distinguished  from  arsenic  sul- 
phide in  being  soluble  in  acids  and  insoluble  in  alkalies, 
and  further  in  forming  a  brown  oxide  instead  of  a  ring 
when  dried  and  oxidized  on  charcoal. 

The  special  tests  for  the  detection  of  arsenious  oxide  are 
known  as  Marsh's  and  Reinsch's  tests.  The  principle  of 
Marsh's  test  is  based  upon  the  fact  that  arsenious  oxide  is 
decomposed  in  the  presence  of  nascent  hydrogen,  arseni- 
urettcd  hydrogen  gas  being  formed  from  which  the  arsenic 
can  be  obtained  as  a  brilliant  steel  or  brown-gray  deposit 
in  the  form  of  rings.  The  simplest  method  of  performing 
Marsh's  test  is  first  to  generate  perfectly  pure  hydrogen 
gas  and  then  to  add  to  the  materials  generating  the  latter 


MEDICAL   JUKISPKUDENCE    AND   TOXICOLOGY.      207 

the  solution  suspected  to  contain  arsenious  oxide.  The 
hydrogen  gas  may  be  generated  by  putting  strips  of  chem- 
ically pure  zinc  and  diluted  sulphuric-  acid  into  a  suitable 
glass  vessel  provided  with  two  mouths.  Through  one  of 
the  mouths  a  glass  tube  should  pass  down  vertically  below 
the  surface  of  the  liquid,  and  through  the  other  mouth  a 
tube  bent  at  right  angles  by  means  of  which  the  hydrogen 
gas  generated  may  issue.  The  gas  should  be  dried  by  al- 
lowing it  to  pass  through  a  tube  containing  pieces  of  fused 
calcium  chloride  or  pumice-stone  moistened  with  sulphuric 
acid,  then  through  a  horizontal  tube  of  hard  German  glass 
about  a  foot  long,  turned  up  at  the  farthest  end  and  ter- 
minating in  a  small  point,  so  that  the  gas  as  it  escapes  will 
burn  in  a  jet.  It  is  most  essential,  before  lighting  the  jet 
of  gas,  that  all  atmospheric  air  be  excluded  from  the  tubes, 
otherwise  a  violent  explosion  will  ensue.  After  waiting  a 
sufficient  length  of  time  the  gas  may  be  lighted,  and  it  will 
burn  with  a  faintly  luminous,  scarcely  perceptible  flame. 
The  purity  of  the  materials  used  in  generating  the  hydro- 
gen gas  must  now  be  demonstrated.  This  is  accomplished 
by  applying  the  flame  of  a  large  spirit-lamp  to  the  hori- 
zontal glass  tube  until  it  becomes  red  hot.  Should  no  stain 
or  deposit  occur  just  beyond  the  heated  spot,  or  no  deposit 
form  ou  a  piece  of  white  porcelain  held  over  the  burning 
jet,  the  absence  of  arsenic  is  assured  (Fig.  43).  A  small 
quantity  of  the  suspected  solution  being  now  introduced 
through  the  vertical  tube,  any  arsenious  oxide  present  will 
be  decomposed,  arseniuretted  hydrogen  will  be  set  free,  and 
will  burn  with  a  pale  blue  flame,  white  fumes  being  fre- 
quently evolved  having  an  alliaceous  odor.  If  the  latter 
be  made  to  pass  into  a  short  wide  glass  tube,  they  will  con- 
dense as  a  white  powder,  sometimes  crystalline  in  form, 
recognizable  as  arsenious  oxide.      If  a  white  porcelain 


208  ,  A    MANUAL   OF 

plate  be  now  placed  over  the  flame  of  the  arseniuretted 
hydrogen,  a  deposit  is  formed  consisting  of  three  concen- 
tric rings,  the  inner  ring  being  metallic  arsenic,  the  middle 
ring  arsenic  and  arsenious  oxide,  the  outer  ring  arsenious 
oxide. 

It  should  be  mentioned,  in  connection  with  Marsh's  test, 
that  antimony  in  the  presence  of  hydrogen  will  yield  a 
deposit  very  similar  to  that  due  to  arsenic.  The  arsenical 
deposit  can,  however,  be  distinguished  from  the  antimo- 
nial  one,  as  the  former  is  soluble  in  a  solution  of  chlori- 
nated lime,  but  insoluble  in  hydrochloric  acid,  whereas 
the  latter  is  insoluble  in  chlorinated  lime,  but  soluble  in 
hydrochloric  acid.  Further,  if  the  deposit  of  arsenious 
oxide  be  converted  into  arsenic  acid  by  the  addition  of 
nitric  acid,  and  the  latter  be  treated  with  ammonio-nitrate 
of  silver,  the  brick-red  arsenite  of  silver  will  be  formed, 
affording  another  proof  of  the  presence  of  arsenic.  On 
placing  the  flame  of  a  large  spirit-lamp  just  below  the 
horizontal  tube,  which  should  have  been  contracted  after 
heating  it  in  several  places,  when  it  becomes  nearly  red 
hot  a  deposit  of  metallic  arsenic  will  be  formed  just  in 
advance  of  the  flame,  the  deposit  continuing  to  increase 
until  it  may  occupy  the  whole  of  the  contracted  space,  or 
even  part  of  the  tube  in  advance  of  the  latter.  This 
deposit  constitutes  what  is  known  as  the  arsenical  mirror, 
and  should  be  exhibited  in  court  as  proof  that  arsenic  had 
been  found. 

Reinsch's  test  consists  in  boiling  bright  strips  of  copper 
in  a  hot  solution  of  the  suspected  substance  previously 
acidulated  by  hydrochloric  acid.  Metallic  arsenic  being 
deposited  upon  the  strips  of  copper,  the  latter  are  then 
withdrawn  and  placed  in  a  reduction-tube  and  the  presence 
of  arsenic  demonstrated  in  the  manner  already  described. 


MEDICAL  JURISPRUDENCE   AND   TOXICOLOGY.      209 

The  freedom  from  arsenic  of  the  copper  strips  used  in 
Reinsch's  test  is  shown  by  the  faet  that  they  are  not 
tarnished  after  having  been  boiled  in  hydrochloric  acid. 
As  antimony  and  mercury  can  be  determined  in  the 
same  manner  as  arsenic  by  tin's  test,  it  should  be  men- 
tioned that  the  deposit  of  antimony  is  violet,  its  sublimate 
amorphous  and  insoluble  in  water;  that  of  mercury  bright 
and  silvery,  its  sublimate  consisting  of  bright  metallic 
globules;  that  of  arsenic  is  steel-gray,  its  sublimate  con- 
sisting of  octahedral  crystals  slightly  soluble  in  water. 

Aceto-arsenite  of  copper  or  Brunswick  green,  also  known 
as  Vienna  emerald  or  Paris  green,  not  unfrequently  causes 
death  by  poisoning,  this  pigment  being  extensively  used 
in  the  staining  of  wall-paper,  toys,  bonbon  papers,  in 
coloring  artificial  flowers,  articles  of  dress,  bonnets,  etc. 
Cases  of  arsenical  poisoning  from  this  pigment  are  usually 
chronic  in  character,  resulting  from  living  in  rooms  whose 
walls  are  covered  with  this  green  paper,  the  fine  dust  from 
which,  getting  into  the  lungs,  produces  the  poisonous  ef- 
fects. Death  may  also  result  from  overdoses  of  Fowler's 
solution  or  liquor  potassae  arsenitis,  from  arsenic  acid, 
Scheele's  green  or  arsenite  of  copper,  and  orpiment,  or 
the  yellow  sulphide  of  arsenic. 

Poisoning  by  Antimony. — Of  the  different  preparations  of 
antimony  the  potassio-tartrate,  or  tartar  emetic,  is  the  most 
important  medico-legally,  though  the  chloride  is  not  unfre- 
quently also  a  cause  of  death.  The  symptoms  of  antimonial 
poisoning  are  a  strong  metallic  taste  during  the  act  of  swal- 
lowing, heat,  soreness,  and  constriction  of  the  throat,  pain 
in  the  stomach,  followed  by  nausea,  vomiting,  and  diarrhoea. 
The  pulse  is  quick  and  small,  the  skin  is  cold  and  clammy, 
cramps  are  often  present  in  the  extremities.  The  urine  is 
often  increased  in  quantity,  but  voided  with  pain.  Death 
14 


210  A    MANUAL    OF 

may  take  place  during  the  stage  of  prostration,  which  is 
very  intense,  or  may  be  preceded  by  delirium  and  con- 
vulsions. Insensibility  is  sometimes  produced  by  the 
taking  of  large  doses.  Cases  of  chronic  poisoning  by  anti- 
mony are  characterized  by  great  weakness  and  exhaustion, 
accompanied  by  nausea,  vomiting,  and  purging.  In  cases 
of  antimonial  poisoning,  should  vomiting  not  have  been 
induced  by  the  poison,  the  fauces  should  be  tickled  and 
hot  water  and  milk  administered,  the  stomach-pump  being 
used  as  a  last  resource.  As  soon  as  the  poison  has  been 
removed  from  the  stomach  strong  coffee  should  be  given, 
followed  by  opium. 

The  antidotes  are  any  substances  that  contain  tannin, 
such  as  cinchona  bark,  .green  tea,  infusion  of  nutgalls,  and 
decoction  of  oak  bark,  etc.  As  well  known,  infants  and 
young  children  tolerate  large  doses  of  tartar  emetic,  espe- 
cially when  suffering  from  diseases  of  the  larynx  and 
lungs.  Three-quarters  of  a  grain  has  nevertheless  proved 
fatal  in  a  child,  and  two  grains  in  an  adult.1  The  recov- 
eries reported  after  the  taking  of  large  doses  were  without 
doubt  due  to  the  poison  having  been  rejected  by  the  stom- 
ach, vomiting  having  been  promptly  induced.  Death  may 
take  place  within  a  period  varying  from  a  few  hours  to  a 
few  days,  though  it  may  not  take  place  for  many  months. 
The  post-mortem  appearances  usually  found  are  inflamma- 
tion of  the  mucous  membrane  of  the  stomach  and  intes- 
tines, and  in  some  cases  of  the  brain  and  lungs.  The 
liver  is  frequently  enlarged  and  softened,  and  appears  to 
have  undergone  a  fatty  degeneration. 

In  the  extraction  of  tartar  emetic  from  the  stomach  the 
contents  of  the  latter  should  be  diluted  with  water,  filtered, 

1  For  the  different  properties  of  arsenic  and  antimony,  see  Wharton 
and  Stille,  op.  cit.,  vol.  ii.  p.  201. 


MEDICAL   JURISPRUDENCE    AMi   TOXICOLOGY.      '211 

and  acidulated  with  tartaric  acid,  and  then  sulphuretted- 
hydrogen  gas  passed  through  the  liquid,  by  which  means 

the  orange  sulphide  of  antimony,  which  is  soluble  in  sul- 
phide of  ammonium,  will  he  precipitated.  Should  anti- 
mony fail  to  be  detected  by  this  method,  then  Marsh's  or 
Ilcinsch's  test  should  be  tried.  Antimony  is  absorbed  in 
the  system,  and  may  be  found  in  the  viscera,  blood,  urine, 
the  same  methods  being  made  use  of  as  iu  the  case  of 
arsenical  poisoning.  If  the  quantity  of  antimony  sus- 
pected to  be  present  is  very  small,  a  coil  of  pure  zinc- foil 
wound  around  a  platinum  foil  may  be  suspended  in  a 
weak  acidified  solution,  when  the  metallic  antimony  will 
be  deposited  upon  the  platinum.  The  deposit  so  obtained 
should  then  be  washed  and  digested  in  nitric  acid  until 
it  is  dissolved,  and  the  solution  then  evaporated.  The 
residue,  being  acidified,  should  then  be  treated  with  sul- 
phuretted hydrogen.  It  may  be  mentioned,  in  this  con- 
nection, as  tartar  emetic  is  very  often  prescribed  medici- 
nally, that  the  medical  examiner  should  be  very  cautious 
in  attributing  death  to  poison  in  case  of  finding  this  salt 
in  the  stomach,  unless  it  were  obtained  in  quantity  far  ex- 
ceeding that  of  ordinary  doses. 

The  symptoms  and  post-mortem  appearances  presented 
in  cases  of  poisoning  by  chloride  or  butter  of  antimony 
resemble  rather  those  produced  by  mineral  acids  than  by 
tartar  emetic.  Chloride  of  antimony  when  thrown  into 
water  yields  a  copious  white  flaky  precipitate,  the  oxy- 
chloride  or  powder  of  Algaroth.  The  latter  is  soluble  in 
tartaric  acid,  and  turns  orange-red  when  touched  by  sul- 
phide of  ammonium. 

Poisoning  by  Merem*y. — While  all  the  mercurial  com- 
pounds, corrosive  sublimate,  calomel,  red  and  white  precip- 
itates, red  oxide,  etc.,  are  more  or  less  poisonous,  mercuric 


212  A    MANUAL    OF 

chloride  or  corrosive  sublimate,  from  a  medico-legal  point 
of  view,  is  the  most  important. 

The  symptoms  in  cases  of  acute  mercurial  poisoning  ap- 
pear usually  immediately  after  the  poison  is  taken,  a  burn- 
ing pain  being  at  once  felt  extending  from  the  throat  to 
the  stomach.  The  face  becomes  flushed.  The  mouth  and 
tongue  look  white  and  shrivelled,  as  if  they  had  been 
thoroughly  painted  with  silver  nitrate.  The  breathing  is 
difficult,  the  pulse  thready.  The  abdomen  is  painful  and 
swollen,  the  pain  being  increased  upon  pressure.  The 
stools  are  bloody.  The  thirst  is  intense,  and  a  white, 
stringy,  or  bloody  mucus  is  vomited.  The  urine  is  more 
or  less  suppressed.  The  skin  is  cold  and  clammy.  Sali- 
vation usually  sets  in  about  the  third  day.  Death  gene- 
rally takes  place  soon  from  collapse,  though  it  may  be  pre- 
ceded by  convulsions  and  coma.  The  antidotes,  white  of 
egg,  or  wheat  flower  mixed  with  milk,  should  be  given  at 
once,  and  in  most  cases  continued  two  or  three  times  daily 
for  some  weeks.  The  white  of  one  egg  may  be  considered 
as  sufficient  to  neutralize  four  grains  of  corrosive  subli- 
mate. As  the  vapors  of  mercury  are  poisonous  when  in- 
haled, it  not  unfrequently  happens  that  those  who  are  en- 
gaged in  working  mercurial  ores,  in  looking-glass  plating, 
water-gilders,  barometer-makers,  are  poisoned  in  this  way, 
the  fumes  being  given  off  from  the  metal  even  at  ordinary 
temperatures.  Such  cases  are  usually  chronic  in  character. 
The  symptoms  begin  with  nausea  and  vomiting.  Coppery 
taste  in  the  mouth  and  pains  in  the  stomach  are  constantly 
occurring.  The  breath  becomes  fetid  and  swallowing  diffi- 
cult. A  hacking  cough  sometimes  follows,  with  haemoptysis. 
Ultimately  salivation  becomes  very  noticeable.  The  mar- 
gins of  the  gums  sometimes  present  a  blue  line  like  that  ob- 
served in  lead-poisoning,  the  gums  being  red,  painful,  swol- 


MEDICAL  JURISPRUDENCE  AND   TOXICOLOGY.     213 

Ion,  and  eveu  ulcerated.  Tremors  and  convulsive  move- 
ments of  the  limbs  finally  become  well  marked,  and  the 
patient,  soon  dies  unless  actively  treated.  The  smallest 
quantity  of  corrosive  sublimate  known  to  have  proved 
fatal  is  three  grains.1  Death  usually  takes  place  within  a 
period  varying  from  three  to  six  days,  though  it  has  oc- 
curred within  half  an  hour  in  some  cases,  and  been  pro- 
tracted in  others  more  than  two  weeks. 

On  post-mortem  examination  the  salivary  glands  are 
found  enlarged.  The  abdomen  is  usually  tympanitic. 
The  mucous  membrane  of  the  mouth  and  throat  presents  a 
grayish-white  color,  at  times  being  exceedingly  inflamed 
or  corroded,  or  even  in  a  sloughy  condition.  The  stomach 
is  often  very  much  inflamed,  and  is  frequently  covered 
with  a  slate-colored  layer  of  finely-divided  mercury,  or,  in 
cases  of  putrefaction,  with  a  black  precipitate  of  sulphide 
of  mercury.  The  intestines  and  urinary  bladder  are  often 
also  much  inflamed.  In  order  to  determine  the  presence 
of  mercury  in  the  stomach  the  contents  of  the  latter  should 
be  mixed  and  crushed  in  a  mortar,  alcohol  being  added  to 
facilitate  filtration.  The  mixture,  being  acidified  with  hy- 
drochloric acid  aud  gently  warmed,  should  then  be  fil- 
tered, and  the  filtrate  tested  by  sulphuretted  hydrogen  and 
Reinsch's  test.  In  order,  however,  to  obtain  corrosive 
sublimate  from  the  stomach,  the  contents  should  be  con- 
centrated by  evaporation,  and  then  shaken  with  a  large 
bulk  of  ether,  which  is  a  powerful  solvent  of  corrosive 
sublimate.  The  ether  must  then  be  carefully  decanted  and 
distilled  at  a  gentle  heat,  the  residue  being  then  appropri- 
ately tested.  Corrosive  sublimate  may  be  found  in  the 
urine  within  two  hours  and  in  the  saliva  within  four 
hours  after  the  taking  of  the  poison.  In  examining  the 
1  Taylor:  op.  cat.,  p.  141. 


214  A    MANUAL   OF 

urine  about  fourteen  ounces  should  be  evaporated  down 
to  one  ounce  and  acidified  and  filtered.  The  filtrate 
should  then  be  boiled  with  a  piece  of  bright  copper  and 
placed  in  a  reduction  tube.  The  saliva  may  be  tested  by 
observing  whether  a  piece  of  bright  copper  becomes  tar- 
nished when  placed  in  saliva  acidulated  with  hydrochloric 
acid.  Among  the  tests  for  the  mercurous  salts  may  be 
mentioned  liquor  calcis,  which  throws  down  a  black  pre- 
cipitate (black  wash).  Iodide  of  potassium  gives  an  olive- 
green  precipitate,  chromate  of  potassium  gives  a  bright  red 
precipitate.  With  mercuric  salts  liquor  calcis  gives  a  yel- 
low precipitate  (yellow  wash).  With  corrosive  sublimate 
liquor  ammonias  gives  a  white  precipitate.  Iodide  of  po- 
tassium gives  the  scarlet  iodide  of  mercury. 

From  a  medico-legal  point  of  view  it  is  important  for 
the  practitioner  to  bear  in  mind  that  the  symptoms  of 
mercurial  salivation  closely  resemble  those  due  to  cancrum 
oris  or  gangrene  of  the  mouth,  as  suits  for  damages  have 
been  brought  against  physicians  by  their  patients  on  the 
charge  that  they  had  been  poisoned  by  the  mercury  admin- 
istered, when  they  were  really  suffering  from  one  or  other 
of  the  diseases  just  mentioned.1  Indeed,  suits  for  mal- 
practice have  been  instituted  in  which  it  was  afterwards 
shown  that  no  mercury  in  any  form  whatsoever  had  been 
prescribed.  In  cases  of  this  kind  the  chemical  analysis 
of  the  saliva  would  at  once  settle  the  question. 

Poisoning  by  Lead. — The  most  important  salts  of  lead, 
from  a  medico-legal  point  of  view,  are  the  acetate  and 
carbonate,  though  other  preparations  of  lead  are  used  for 
medicinal  purposes.  Cases  of  acute  lead  poisoning  are 
very  rare,  and  when  they  occur  result  from  accident. 
Soon  after  swallowing  acetate  of  lead,  or  sugar  of  lead,  a 
1  Christison:  op.  cit.,  p.  412. 


MEDICAL   JURISPRUDENCE    AM)   TOXICOLOGY.      215 

metallic  taste,  dryness  in  the  throat.,  and  thirsi  are  expe- 
rienced. The  most  prominent  symptom,  however,  is  severe 
colicky  pain,  which  is  intermittent,  but  is  relieved  by  pres- 
sure. Constipation  is  invariably  present,  the  muscular  coat 
of  the  intestines  being  paralyzed.  The  urine  is  scanty  and 
red,  cold  sweats,  cramps,  paralysis  of  the  lower  extremities, 
appear  as  the  case  progresses,  followed  often  by  tetanic 
spasms  and  convulsions. 

In  treating  cases  of  acnte  lead  poisoning  emetics  should 
be  given,  and  if  vomiting  should  not  be  induced  by  these 
means  then  the  stomach-pump  should  be  resorted  to.  The 
antidotes  are  the  soluble  alkaline  and  earthy  sulphates ; 
the  sulphate  of  magnesium  is  the  best,  and  should  be  ad- 
ministered with  eggs,  opium  being  given  to  allay  pain. 
The  amount  of  acetate  of  lead  that  would  prove  fatal,  and 
the  length  of  time  that  would  elapse  before  death  took 
place,  are  uncertain.  Cases  of  chronic  or  slow  lead  poi- 
soning or  saturnine  poisoning  are  of  very  frequent  occur- 
rence, owing  to  the  various  ways  in  which  lead  in  one 
form  or  another  may  be  introduced  into  the  system.  It  may 
be  swallowed  in  drinking-water  or  applied  in  the  form  of 
cosmetics  or  hair-dyes,  or  inhaled  in  the  form  of  fumes,  as 
by  artists,  painters,  plumbers,  aud  workmen  engaged  in  the 
manufacture  of  white-lead.1 

The  symptoms  that  appear  first  in  chronic  cases  are  col- 
lectively known  as  lead  colic,  among  which  the  blue  line 
at  the  margin  of  the  gums  is  very  characteristic,  aud  those 
later  as  lead  palsy.  On  post-mortem  examination  in  cases 
of  acute  lead  poisoning,  inflammation  of  the  alimentary 
canal  may  be  found ;  but,  not  unfrequently,  no  lesion  of 
any  kind  is  present.  In  cases  of  chronic  poisoning  no 
special  lesion  is  found,  with  the  exception  that  the  intes- 
1  Guy  and  Ferrier :  op.  cit.,  p.  494. 


216  A   MANUAL   OF 

tines  are  usually  in  a  contracted  condition  and  the  muscles 
specially  affected  flabby.  Lead,  however,  is  found  in  the 
bones,  brain  and  spinal  cord,  and  viscera.  In  extracting 
lead  from  the  stomach  the  contents  should  be  treated  with 
dilute  nitric  acid  in  order  to  form  nitrate  of  lead,  the 
latter  being  then  treated  with  sulphuretted  hydrogen.  If 
the  lead  has,  however,  been  rendered  insoluble  by  any 
organic  matters  normally  present,  or  by  the  antidotes,  then 
the  contents  of  the  stomach  should  be  first  incinerated, 
and  the  ash  treated  in  the  manner  just  mentioned.  The 
black'  precipitate  so  obtained  can  be  shown  to  contain  lead 
by  reducing  it  by  means  of  charcoal  and  the  blow-pipe. 

Poisoning  by  Copper. — The  salts  of  copper  are  rarely  used 
for  homicidal  or  suicidal  purposes.  Most  cases  of  poisoning 
by  copper  result  from  accident,  being  caused,  for  example, 
by  keeping  food,  or  cooking,  in  copper  vessels.  Green  car- 
bonate of  copper,  or  natural  verdigris,  is  formed  under  such 
circumstances,  and  is  very  poisonous.  All  the  salts  of  copper 
are  poisonous.  The  sulphate,  or  blue  vitriol,  and  the  subace- 
tate  or  artificial  verdigris,  are  the  most  important  from  a 
medico-legal  point  of  view.  In  large  doses  sulphate  of 
copper  is  a  powerful  emetic ;  fatal  results  are  often  on  that 
account  prevented,  the  poisonous  matters  swallowed  being 
at  once  rejected  by  the  stomach.  Among  the  other  symp- 
toms presented  are  thirst,  abdominal  pain,  purging,  sup- 
pression of  urine,  jaundice.  In  cases  of  copper  poisoning, 
vomiting  should  be  induced,  or  the  stomach-pump  resorted 
to  in  case  the  poison  has  not  produced  that  effect.  White 
of  egg,  mixed  with  eggs  and  milk,  should  be  freely  ad- 
ministered. On  post-mortem  examination  the  body  will 
be  found  to  present  a  yellow  color.  The  mucous  mem- 
brane of  the  stomach  is  usually  inflamed,  and  its  contents 
are  of  a  blue  color.     An  ounce  of  sulphate  of  copper  has 


MEDICAL  JURISPRUDENCE   AND   TOXICOLOGY.      217 

proved  fatal ;  but  the  quantity  necessary  to  destroy  life,  as 
well  as  the  period  at  which  death  occurs,  is  variable.1  In 
extracting  a  salt  of  copper  the  contents  of  the  stomach 
should  be  evacuated  and  treated  with  dilute  hydrochloric 
acid  and  filtered;  the  filtrate  being  then  treated  with  sul- 
phuretted hydrogen.  The  blackish-brown  precipitate  of 
sulphide  of  copper  should  then  be  converted  into  the 
nitrate  by  the  addition  of  nitric  acid,  and  the  latter  salt 
tested.  A  convenient  test  for  salts  of  copper  is  liquor  am- 
monia?, which  gives  a  blue  precipitate;  the  latter,  when 
dissolved  in  an  excess  of  ammonia,  forms  a  beautiful  sap- 
phire-blue. 

Poisoning  by  Zinc,  Bismuth,  etc. — Cases  of  poisoning  from 
zinc  are  comparatively  rare.  Of  the  different  preparations, 
the  sulphate  and  chloride,  the  latter  often  used  as  a  disin- 
fectant, need  only  be  considered.  The  symptoms  of  poison- 
ing by  zinc  resemble  those  due  to  sulphate  of  copper.  Half 
an  ounce  to  an  ounce  has  proved  fatal.  In  some  instances 
death  has  occurred  within  fourteen  hours.  The  post-mortem 
appearance  presented  is  inflammation  of  the  alimentary 
canal.  The  best  antidote  is  albumen.  Bismuth,  more 
particularly  the  subnitrate,  deserves  mention  on  ac- 
count of  its  being  frequently  adulterated  with  arsenic. 
Indeed,  the  finding  of  arsenic,  when  the  cause  of  death 
was  alleged  to  be  poisoning,  has  been  accounted  for 
on  the  supposition  that  it  was  given  in  the  subnitrate 
of  bismuth  administered.2  With  respect  to  the  prepa- 
rations of  chromium,  it  should  be  mentioned  that  not 
unfrequently  fatal  cases  of  poisoning  have  resulted  from 
persons  eating  cakes  and  buns  colored  yellow  by  means  of 
chromate  of  lead.     Although  the  various  preparations  of 

1  Woodman  and  Tidy :  op.  cit.,  p.  175. 

2  Wharton  and  Stille:  op.  cit.,  vol.  ii.  pp.  283,  571. 


218  A   MANUAL  OF 

tin,  iron,  silver,  gold,  and  manganese  may  all  prove  fatal 
when  taken  in  large  doses,  as  they  are  so  unlikely  to  be 
used  for  poisoning  purposes,  and  of  thus  becoming  the 
subject  of  medico-legal  inquiry,  their  special  consideration 
can  be  dispensed  with. 

Poisoning  by  Oxalic  Acid. — Of  the  irritant  poisons 
of  vegetable  origin,  oxalic  acid  is  the  most  important. 
Resembling  sulphate  of  magnesium  or  Epsom  salts,  for 
which  it  is  readily  mistaken,  and  being  easily  procured 
either  as  oxalic  acid'  or  as  salt  of  sorrel,  salt  of  lemons, 
potassium  oxalate,  it  is  not  unfrequently  taken  by  acci- 
dent or  for  suicidal  purposes.  The  symptoms  of  poisoning 
by  oxalic  acid  are  a  hot,  burning,  acid  taste  during  swal- 
lowing, followed  by  pallor,  clammy  perspiration,  extreme 
prostration,  abdominal  pain,  accompanied  with  vomiting. 
If  the  poison  be  diluted,  the  vomiting  may  be  protracted. 
In  some  cases,  however,  there  is  no  vomiting  at  all ;  in 
others  it  may  continue  incessantly  until  death  The  nerv- 
ous system  appears  to  be  also  remotely  affected,  as,  in  cases 
of  recovery  from  oxalic  acid  poisoning,  spasmodic  twitch- 
ings  of  the  facial  muscles,  temporary  loss  of  voice,  numb- 
ness and  tingling  of  the  legs  have  been  observed  In 
treating  cases  of  oxalic  acid  poisoning,  magnesia,  plaster 
from  the  walls,  chalk  or  carbonate  of  calcium,  should  be 
given ;  the  last  is  the  best  remedy,  as  it  forms  with  oxalic 
acid  the  inert  calcium  oxalate.  Vomiting  should  after- 
ward be  induced  by  an  emetic  of  sulphate  of  zinc.  Alka- 
lies and  their  carbonates  should  not  be  given,  however, 
under  any  circumstances,  as  the  salts  formed  would  be  as 
poisonous  as  the  oxalic  acid.  The  mucous  membrane  of 
the  mouth,  tongue,  and  throat  appears  as  if  bleached.  The 
stomach  is  often  black,  and  even  gangrenous,  though  per- 
foration is  rare.     It  often  contains  a  dark-brown  liquid. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      '21 9 

One  drachm  of  oxalic  acid  lias  proved  fatal.1  Death  may 
take  place  very  quickly,  or  may  be  protracted  several  days. 
Through  the  addition  of  acetate  of  lead  to  the  contents  of 
the  stomach  previously  filtered  oxalate  of  lead  is  precipi- 
tated; the  latter  being  treated  with  sulphuretted  hydrogen, 
oxalic  acid  is  set  free  and  the  lead  is  precipitated  as  sul- 
phide of  lead. 

A  convenient  test  for  oxalic  acid  is  calcium  sulphate, 
which  gives  a  white  precipitate  of  calcium  oxalate  soluble 
in  mineral,  but  insoluble  in  vegetable  acids.  It  may  be 
mentioned,  in  this  connection,  that  both  tartaric  and  acetic 
acids  have  proved  fatal  when  taken  in  doses  of  an  ounce. 
In  the  treatment  of  such  cases,  magnesia,  chalk,  or  the 
alkaline  carbonates  may  be  given. 

Poisoning  by  Carbolic  Acid. — Carbolic  acid,  sometimes 
called  coal-tar  creasote,  is  so  extensively  used  as  an  anti- 
septic and  is  so  powerful  a  poison  that  it  demands  at  least 
brief  mention.  The  symptoms  of  poisoning  are  vertigo 
and  intoxication,  accompanied  by  intense  burning  pain 
in  the  mouth  and  stomach,  with  vomiting  of  frothy 
mucus.  The  pupils  are  contracted ;  the  pulse  rapid  and 
intermittent.  The  urine  is  frequently  suppressed  ;  what- 
ever is  passed  is  dark-colored  and  smoky  ;  convulsions  and 
coma  often  supervene.  In  treating  such  cases  oil  and  de- 
mulcent drinks,  sulphate  of  sodium  or  Glauber's  salts  may 
be  administered,  and  the  stomach-pump  should  be  used. 
With  any  treatment,  however,  there  is  but  little  chance  of 
recovery.  Six  or  seven  drops  having  caused  the  most  dan- 
gerous symptoms,  it  is  to  be  expected  that  death  will 
follow  almost  immediately  after  the  taking  of  any  large 
quantity.  Indeed,  death  has  been  known  to  take  place 
within  ten  minutes  after  swallowing  about  an  ounce  of  car- 
1  Taylor :  op.  cit.,  p.  105. 


220 


A   MANUAL   OF 


bolic  acid,  though  life  may  be  protracted  two  or  three  days.1 
As  a  general  rule,  after  death  the  mouth,  oesophagus,  and 
stomach  are  found  white  and  corroded.  The  lungs  are  usu- 
ally found  much  congested  ;  the  brain  occasionally  so.  Car- 
bolic acid  can  be  usually  found  in  the  urine  by  agitating 
the  latter  with  an  excess  of  ether,  removing  the  ether  by 
means  of  a  pipette  and  evaporating.  The  minute  oily 
residue  left  has  the  character  of  that  acid.  The  best  gen- 
eral test  for  carbolic  acid  is  probably  its  odor. 

Poisoning  by  Vegetable  Substances. — There  are  a  number 
of  well-known  substances,  such  as  croton  oil,  the  oil  of 


Fig.  44. 


Fig.  45. 


Leaf  of  the  Croton  tiglium. 


Colchicum  autumnale :  a,  flower- 
ing plant ;  b,  stigmas  ;  c,  leaves  and 
fruit. 


the  seed  of  Croton  tiglium   (Fig.  44),  ergot  of  rye,  the 

fool's  parsley  {JEthusa  cynapium),  elaterium  obtained  from 

1  Woodman  and  Tidy  :  op.  cit.,  p.  516. 


MEDICAL  JURISPRUDENCE    AND   TOXICOLOGY.     221 

the  wild  cucumber,  water  dropwort  {CEnanihe  crocata), 
castor-oil  beans,  seeds  and  wine  of  colchicum  (Fig. 
45),  cow  bane  (Ciouta  virosa),  oil  of  savin  procured  from 
the  toys  of  juniperus  sabina,  yellow  jessamine,  veratrum 
viride,  and  the  other  species  of  hellebore,  all  of  which 
possess  poisonous  properties  of  an  irritant  character.  As 
cases  of  poisoning  by  these  substances  arc  usually  accidental 
in  character  and  unlikely  to  become  the  subject  of  medico- 
legal inquiry  except  in  the  case  of  oil  of  savin  often  used 
as  an  abortive,  it  will'  not  be  necessary  to  dwell  upon  their 
characteristic  properties. 

Poisoning  by  Eating  Fungi. — The  symptoms  caused  by 
eating  poisouous  fungi,  often  resembling  those  due  to  poison 
administered  with  homicidal  intent,  demand  some  consider- 
ation on  the  part  of  the  medical  jurist.  As  is  well  known, 
while  certain  fungi  may  be  eaten  usually  with  impunity, 
there  are  others  which  invariably  prove  poisonous.  The 
symptoms  which  follow  the  eating  of  poisonous  mushrooms, 
and  which  usually  appear  within  an  hour,  are  giddiness, 
thirst,  abdominal  pain,  vomiting,  purging,  sweats,  dimness 
of  vision,  delirium,  convulsions,  and  coma.1  Death  usually 
takes  place  within  twenty-four  hours.  In  treating  such 
cases  the  stomach-pump  should  be  used  and  an  emetic  of 
sulphate  of  zinc  and  castor  oil  should  be  administered.  On 
post-mortem  examination  the  stomach  and  intestines  are 
usually  found  inflamed  and  may  even  be  gangrenous.  The 
contents  of  the  stomach  should  be  carefully  searched  for  the 
gills  and  spores  of  the  mushroom  suspected  to  have  been  the 
cause  of  poisoning,  the  particular  fungus  being  by  these 
means  identified. 

Poisoning  by  Decomposed  Food. — The  irritant  poisons 
of  animal  origin  are  cantharides  and  the  poisons  devel- 
1  Casper :  op.  cit.,  vol.  ii.  p.  61. 


222 


A    MANUAL    OF 


Cantharis  vesicatoria  (Spanish  fly). 


oped    under  certain  circumstances  in  food.     The  symp- 
toms of  poisoning  from  the  powdered   Cantharis  vesica- 
toria (Fig.  46),  or  the  tinc- 
Fig.  46.  ture  of  cantharides,  are  pain 

in  swallowing,  a  burning 
sensation  in  the  mouth  and 
stomach,  thirst,  vomiting, 
and  bloody  stools,  priapism, 
inflammation  and  swelling 
of  the  genitalia,  and  occa- 
sionally convulsions  and  de- 
lirium. In  treating  a  case 
of  poisoning  from  such  a 
cause,  emetics  and  thick 
warm  liquids  should  be  administered,  opiates  should 
be  given  in  the  form  of  enema,  and  suppositories  and 
leeches  applied.  On  post-mortem  examination  the  mu- 
cous membrane  of  the  alimentary  canal  and  urino-genitary 
tract  will  be  found  inflamed.  Portions  of  the  wings  and 
wing-cases  of  the  insect,  which  resist  putrefaction  for  a 
long  time,  should  be  looked  for,  especially  in  the  large  in- 
testine. An  ounce  of  the  tincture  of  cantharides  has 
proved  fatal,  death  taking  place  in  twenty-four  hours. 

Poisoning  by  Micro-organisms,  Bacteria,  etc. — Apart 
from  trichinosis  produced  by  eating  raw  pork,  the  mus- 
cular tissue  of  which  is  infested  with  the  minute  worm, 
the  Trichina  spiralis  (Fig.  47),  poisonous  effects  are  fre- 
quently produced  by  eating  food  in  a  state  of  putrefaction 
induced  by  micro-organisms,  bacteria,  etc.,  or  food  con- 
taining ptomaines  or  "  cadaveric  alkaloids,"  so  called  on 
account  of  the  manner  of  their  production  and  of  their 
effects  when  introduced  into  the  system.  The  poison- 
ous effects  frequently  produced  by  eating  meat,  sausage, 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.      22-i 


cheese,  fish,  mussels,  and   puff-paste,  appear  to  be  due 

to  the  presence  of  either  micro-organisms  or  ptomaines.1 
The  symptoms  and  post-mor- 


Trichina  spiralis,  coiled  within  its 
cyst  (X50). 


tern  appearances  in  all  such  Fig.  47. 

cases  are  those  of  an  irritant 
poison  — giddiness,  nausea, 
cramps,  vomiting,  purging — 
the  mucous  membrane  of  the 
alimentary  canal  being  found 
inflamed.  As  to  what  par- 
ticular micro-organism  should 
be  attributed  the  changes  de- 
veloped in  food,  making  it 
poisonous  ;  as  to  the  exact  na- 
ture of  the  ptomaines  which 
cause  poisoning  when  intro- 
duced into  the  system  in  some 
persons,  but  give  rise  to  no 

inconvenience  whatever  in  others,  considerable  difference 
of  opinion  still  prevails  among  bacteriologists  and.  toxicolo- 
gists.  It  is  to  be  regretted,  particularly  from  a  medico- 
legal point  of  view,  that  so  little  has  been  definitely  estab- 
lished with  reference  to  the  nature  of  such  organisms  and 
poisonous  principles,  inasmuch  as  attempts  have  been 
made  in  cases  of  undoubted  poisoning  to  account  for  the 
latter  on  the  supposition  that  the  person  was  poisoned  by 
the  food  eaten  rather  than  by  the  poison  actually  adminis- 
tered with  homicidal  intentions. 

Neurotic  Poisons. — With  opium  we  begin  the  consid- 
eration of  neurotic  poisons,  or  that  class  of  poisons  which 
affect   more   particularly  the  great  nervous    centres — the 
brain  and  spinal  cord.     The  symptoms  produced  by  neu- 
1  Fliigge :  op.  cit.,  p.  567. 


224 


A   MANUAL    OF 


rotic  poisons  are  usually  headache,  giddiness,  drowsiness, 
stupor,  delirium,  convulsions,  paralysis,  there  being,  how- 
ever, little  or  no  inflammation  of  the  mucous  membrane  of 
the  alimentary  canal,  as  was  seen  to  be  so  common  in  cases 
of  poisoning  by  irritants.  The  post-mortem  changes  in  cases 
of  neurotic  poisoning  are  but  few,  and  not  well  marked — 
more  or  less  fulness  of  the  cerebral  vessels  being  observed, 
but  rarely  accompanied  with  effusion  of  serum  or  blood 
in  the  brain. 

Cerebral  Neurotic  Poisons. — Poisoning  by  Opium. — 
In  addition  to  the  different  preparations  of  opium  that 
are  used  medicinally  there  are  a  number  of  patent  medi- 
cines which  contain  this  drug  or  some  of  its  alkaloids, 
among  which  may  be  mentioned  Godfrey's  cordial,  Dalby's 
carminative,  Winslow's  soothing  syrup,  Locock's  pulmonic 
wafers,  Battley's  liquor,  etc.  It  is  on  this  account  that  so 
many  cases  of  poisoning  are  due  to  opium,  the  drug  being 

taken,  in  one  form  or  another, 
either  accidentally  or  suicidal- 
ly, or  administered  to  others 
with  homicidal  intent. 

Opium,  the  concrete  juice 
of  the  unripe  capsule  of  the 
poppy  {Papaver  somniferum  ; 
JFig.  48),  is  a  complex  sub- 
stance containing  a  number 
of  active  principles,  the  chief 
of  which  are  morphia,  me- 
conic  acid,  narcotina,  codeia, 
narceine,  thebaine,  papaver- 
ine. From  a  medico-legal  point  of  view,  however,  morphia 
and  meconic  acid  are  the  most  important  of  these  principles, 
as  by  their  reactions  the  presence  of  opium  is  recognized. 


Papaver  somniferum  (capsule  of  the 
opium  poppy). 


MEDICAL   JUKISPKUDENCE    AND   TOXICOLOGY.      225 

The  symptoms  of  opium  poisoning  arc  giddiness, 
drowsiness,  stupor,  profound  sleep,  flushed  face,  slow  and 
stertorous  breathing,  eyes  closed  and  pupils  contracted,  in- 
sensible to  light,  pulse  rapid  and  small  or  dec  and  slow, 
skin  moist  and  cool.  The  patient,  from  being  aroused 
and  kept  awake  only  with  difficulty,  soon  passes  into  a 
completely  comatose  condition,  death  taking  place  from 
apoplexy,  collapse,  convulsions,  though  usually  tran- 
quilly. 

These  symptoms  miay  appear  within  a  few  minutes  after 
taking  the  drug,  or  be  protracted  for  several  hours,  accord- 
ing to  the  condition  of  the  system  and  the  mode  of  ad- 
ministration; opium,  as  is  well  known,  acts  more  powerfully 
on  a  full  than  an  empty  stomach,  when  the  person  is  at 
rest  than  when  taking  exercise,  and  in  a  liquid  rather  than 
in  a  solid  form.  The  effects  of  taking  opium  habitually 
and  for  a  long  time  are  emaciation,  loss  of  appetite,  con- 
stipation, failure  in  mental  and  physical  vigor,  neuralgic 
pains,  premature  old  age,  and  death.  The  smallest 
quantity  of  opium  known  to  have  produced  death  is  four 
grains.1  The  amount  that  can  be  taken  without  producing 
death,  however,  by  those  persons  habitually  using  opium 
is  almost  incredible.  Indeed,  over  four  thousand  drops  of 
laudanum  have  been  taken  daily  by  a  person  with  whom 
the  author  is  intimately  acquainted,  and  De  Quincey  is  said 
to  have  taken  as  much  as  nine  ounces.  Death  may  take 
place  within  an  hour  or  be  delayed  several  hours.  If  the 
patient  survives  over  twelve  hours,  the  chance  of  recovery 
is  good. 

The  post-mortem   changes  in  cases  of  opium  poisoning 
are  neither  well-marked   nor  constant.     Occasionally  the 
cerebral  vessels  are  found  in  a  turgid  condition,  with  some 
1  Christison :  op.  cit.,  p.  713. 
15 


226  A   MANUAL   OF 

sub-arachnoid  effusion  of  serum  at  the  base  of  the  brain  or 
around  the  spinal  cord. 

In  treating  cases  of  poisoning  by  this  substance,  the  opium 
should  be  removed  by  means  of  the  stomach-pump  as  soon 
as  possible,  or  by  an  emetic  such  as  sulphate  of  zinc  or 
mustard  water.  Cold  water  should  be  dashed  over  the 
face  and  chest  in  order  to  overcome  the  increasiug  lethargy. 
Strong  coffee  should  also  be  administered,  and  the  patient, 
to  be  kept  aroused,  must  be  made  to  walk  between  two 
attendants.  Atropia  should  be  administered  hypodermat- 
ically,  the  effects  upon  the  pupils  being  carefully  watched. 
Should  all  such  remedies  fail,  then  electro-magnetism  may 
be  resorted  to.  The  symptoms  of  poisoning  by  morphia, 
the  most  important  of  the  principles  of  opium,  differ  only 
from  those  produced  by  the  drug  itself  in  manifesting 
themselves  sooner  and  in  tending  to  produce  convulsions 
more  frequently.  One  grain  of  morphia  has  in  more  than 
one  instance  proved  fatal,  and  less  than  a  grain  when  ad- 
ministered hypodermatically.1  The  external  application  of 
morphia  has  also  been  followed  by  fatal  results  when  applied 
externally  to  an  abraded  surface.  The  post-mortem  ap- 
pearances presented  in  cases  of  morphia  poisoning  do  not 
differ  from  those  already  described  as  being  caused  by 
opium. 

There  is  no  direct  chemical  test  for  opium.  As  every 
watery  solution  contains,  however,  meconate  of  morphia,  if 
the  latter  salt  can  by  any  means  be  shown  to  exist  in  the 
contents  of  the  stomach,  the  vomit,  or  the  tissues,  then  in 
this  indirect  way  the  presence  of  opium  may  be  considered 
as  having  been  demonstrated.  The  principle  of  the  analy- 
sis is  based  upon  the  possibility  of  decomposing  the  meco- 
nate of  morphia  that  may  be  present,  and  then  re-obtaining 
1  Wharton  and  Still4 :  op.  cit.,  vol.  ii.  p.  338. 


MEDICAL   JURISPRUDENCE   ANJ)   TOXICOLOGY.      227 

tlio  acid  and  salt  constituting  the  alkaloid  '  as  meconate  of 
lead  and  acetate  of  morphia.  The  process  consists  in  fil- 
tering the  contents  of  the  stomach — any  solid  matters  being 
finely  divided  and  well  mixed  with  liquid.  If  acetic  acid 
be  added  and  then  acetate  of  lead,  meconate  of  lead  will  be 
precipitated,  acetate  of  morphia  remaining  in  solution.  The 
mixture  is  then  filtered  and  tested  in  the  following  manner  : 
The  solution  containing  the  acetate  of  morphia  is  divided 
into  two  parts.  To  one  part  is  added  a  solution  of  perch lo- 
ride  of  iron,  by  which  a  greenish-blue  color  is  produced. 
To  the  other  part,  evaporated  to  dryness,  nitric  acid  is 
added,  by  which  a  yellow  color  becoming  orange-red  is 
developed.  The  precipitate  containing  the  meconate  of 
lead  is  diffused  in  water,  through  which  sulphuretted  hy- 
drogen is  then  passed,  by  which  sulphide  of  lead  is  pre- 
cipitated and  meconic  acid  left  in  solution.  To  the  latter, 
on  the  addition  of  perchloride  of  iron,  a  blood-red  solution 
will  be  formed.  It  must  be  remembered,  however,  that 
even  in  cases  where  there  was  every  reason  to  suppose  that 
opium  had  been  given,  and  when  the  analysis  was  made 
with  the  greatest  care,  not  a  trace  of  either  meconic  acid 
or  morphia  could  be  found. 

Poisoning  by  Alcohol. — The  poisonous  effects  of  alcohol 
are  either  of  an  acute  or  chronic  character.  The  symp- 
toms of  acute  alcoholic  poisoning  are  unsteadiness  of  gait, 
incoherent  talking,  stupor,  and  coma.  The  features  have 
a  vacant  expression,  or  may  be  suffused  and  bloated. 
The  lips  are  livid,  the  pupils  are  unusually  dilated,  bloody 
froth  appears  upon  the  lips,  the  breathing  becomes  difficult 
and  then  stertorous.  In  treating  such  cases  emetics  should 
be  administered,  or  the  stomach-pump  used,  cold  affusions 

1  For  a  detailed  account  of  the  methods  of  detecting  alkaloids  in  sus- 
pected matters,  see  Wharton  and  Stille,  op.  cit.,  vol.  ii.  p.  35-4. 


228  A   MANUAL   OP 

employed,  and  ammonia  and  coffee  given.  On  post-mortem 
examination  the  mucous  membrane  of  the  alimentary 
canal,  the  lungs  and  brain  may  be  found  congested,  with 
serous  effusion  under  the  arachnoid  and  in  the  ventricles. 

Alcoholism,  or  chronic  poisoning  by  alcohol,  as  already 
mentioned,  is  the  proximate  cause  of  numerous  diseases, 
such  as  cirrhosis  of  the  liver,  fatty  liver,  epilepsy,  gastritis, 
disease  of  the  kidneys.  Alcoholism  indirectly  favors  the 
production  of,  and  the  mortality  of,  disease  in  general  by 
diminishing  the  resisting  power  of  the  system.  The  per- 
ceptions finally  become  blunted,  the  moral  and  intellectual 
faculties  are  perverted  by  its  habitual  use,  until  at  last  the 
victim  becomes  a  dipsomaniac.  Alcohol  can  be  obtained 
from  the  stomach  by  distillation.  The  contents  of  the 
stomach,  if  acid,  having  been  neutralized  by  sodium  car- 
bonate, should  be  distilled.  The  distillate,  having  been 
mixed  with  calcium  chloride,  must  be  then  redistilled.  The 
second  distillate  should  then  be  shaken  up  with  dry  sodium 
carbonate,  the  supernatant  fluid  being  drawn  off  for  testing 
purposes. 

Poisoning  by  Ancesthetics. — The  cerebral  neurotics  in- 
clude the  anaesthetics  ether,  chloroform,  and  chloral  hydrate. 
The  symptoms  produced  by  ether  are  very  much  the  same 
as  those  of  alcohol.  When  inhaled,  slow,  prolonged,  ster- 
torous breathing  results,  the  surface  of  the  body  feels  cold, 
the  lips  become  blue,  the  face  pale.  The  pulse  is  at  first 
accelerated,  but  is  afterward  slowed.  The  muscles  become 
relaxed.  The  eyes  are  fixed  and  glassy,  the  pupils  dilated. 
Anaesthesia  becomes  deep,  coma  following  with  entire  loss 
of  sensation.  Nausea  and  vomiting  frequently  occur.  In 
poisoning  by  liquid  ether,  the  stomach-pump  should  be 
employed,  emetics  being  given  afterward.  When  inhala- 
tion has  been  carried  too  far,  the  patient  should  have  plenty 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      229 

of  fresb  air,  cold  affusions  should  be  applied,  and  artificial 
respiration  and  galvanism  resorted  to.  Congestion  of  brain 
and  lungs,  and  the  heart-cavities  filled  with  liquid  dark 
blood,  are  usually  found  upon  post-mortem  examination. 
The  mode  of  extracting  ether  from  the  contents  of  the 
stomach  is  the  same  as  that  made  use  of  in  the  case  of 
alcohol. 

The  symptoms  produced  by  chloroform  when  swallowed 
are  those  of  an  irritant  poison,  but  when  inhaled  the 
symptoms  resemble  those  caused  by  ether,  but  appear 
much  more  rapidly.  Death  is  caused  by  paralysis  of  the 
respiration  and  circulation,  the  nerve-centres  being  prob- 
ably directly  affected,  as  death  in  some  cases  is  almost  in- 
stantaneous. In  treating  cases  of  chloroform  poisoning,  if 
the  chloroform  has  been  taken  in  a  liquid  form,  an  emetic 
should  be  resorted  to,  or  the  stomach-pump  used,  and 
stimulants  administered.  If  the  chloroform  has,  however, 
been  inhaled,  with  the  first  dangerous  symptoms  it  should 
be  instantly  discontinued  and  fresh  air  admitted,  as  a  few 
drops  of  chloroform  may  prove  fatal  in  as  many  seconds. 
Water  should  be  dashed  in  the  face,  the  tongue  pulled  out, 
artificial  respiration  practised,  and  the  galvanic  current 
applied.  The  post-mortem  appearances  presented  in  cases 
of  chloroform  poisoning  are  those  of  death  due  to  as- 
phyxia. Chloroform  can  be  extracted  from  the  stomach  by 
distillation  and  tested  by  passing  the  vapor  through  flame, 
by  which  it  will  be  decomposed  into  carbon,  hydrochloric 
acid,  and  chlorine.  The  carbon  will  be  recognized  by  its 
black  deposit,  the  acid  by  reddening  litmus,  and.  the 
chlorine  by  applying  starch-paper  dipped  in  a  solution  of 
potassium  iodide ;  the  latter  being  decomposed  and  the 
iodine  set  free,  the  starch  will  become  blue. 

Chloral  hydrate,  so  much  used  at  the  present  day  to 


230  A   MANUAL   OF 

procure  sleep,  is  on  that  account  not  iufrequently  a  cause 
of  death,  over-doses  being  taken  accidentally.  In  cases 
of  poisoning  by  it  the  face  becomes  flushed  ;  the  pupils, 
at  first  contracted,  are  then  dilated ;  the  pulse  is  quick  ; 
profound  sleep  is  induced,  which  passes  rapidly  into  coma 
through  cessation  of  the  circulation  and  respiration.  The 
action  of  chloral  hydrate  may  be  possibly  due  to  its  decom- 
position in  the  system,  probably  in  the  blood,  into  an  alka- 
line formiate  and  chloroform.  As  thirty  grains  of  chloral 
hydrate  have  proved  fatal,  that  amount  can  hardly  be  con- 
sidered a  safe  dose  to  begin  with.  Nevertheless,  as  much 
as  an  ounce  has  been  taken  at  once  with  impunity. 

Among  the  cerebral  neurotics  should  be  included  carbon 
monoxide  and  carbon  dioxide,  as  the  effects  of  both  these 
gases  when  inhaled  are  very  similar  to  those  produced  by 
narcotic  poisons.  Carbon  monoxide  is  produced  when 
charcoal  is  burned,  and  frequently  collects  in  pits,  cellars, 
wells,  and  mines.  Carbon  dioxide,  as  is  well  known,  is  one 
of  the  principal  products  of  respiration.  The  symptoms 
of  poisoning  by  both  these  gases  are  essentially  the  same — 
giddiness,  headache,  drowsiness,  insensibility,  and  coma 
being  the  most  prominent. 

In  treating  cases  of  carbon  monoxide  poisoning  vene- 
section and  transfusion  of  arterialized,  defibrinated  blood 
should  be  tried.  In  cases  of  poisoning  by  carbon  dioxide 
the  patient  should  be  given  plenty  of  fresh  air,  the  cold 
douche,  galvanism,  and  stimulants  applied,  artificial  respi- 
ration practised,  etc.  It  will  be  found  much  more  difficult, 
however,  to  revive  a  person  affected  by  carbon  monoxide 
gas  than  by  carbon  dioxide,  the  poisonous  effects  of  the 
latter  being  transitory,  whereas  carbon  monoxide  in  dis- 
placing the  oxygen  of  the  blood  and  forming  a  somewhat 
stable  compound  with  the  haemoglobin  renders  respiration 


MEDTCAL  JURISPRUDENCE   AND   TOXICOLOGY.      231 

very  difficult.  Suicides  are  frequently  committed,  more 
especially  in  France,  by  inhaling  charcoal  vapor;  and 
death  is  often  caused  accidentally  in  America  in  the  same 
way,  as  in  those  cases  where  persons  have  gone  to  sleep  in 
a  room  with  a  charcoal  fire  burning  without  a  flue.  The 
absorbing  effect  of  carbon  monoxide  blood  upon  light 
transmitted  through  it  has  already  been  referred  to  in 
connection  with  the  spectroscopic  examination  of  blood. 

Spinal  Neurotic  Poisons. — Poisoning  by  Strychnia. — 
Strychnia,  one  of  the  most  important  of  poisons  on  account 
of  being  so  frequently  taken  accidentally  or  suicidally,  as 
well  as  given  with  homicidal  intent,  exists,  together  with 
brucia,  in  the  seeds  of  the  strvchnos  mix  vomica,  a  tree 
found  in  India,  The  seeds  owe  their  poisonous  properties 
to  these  two  alkaloids,  and  as  the  symptoms  of  poisoning, 
etc.,  by  nux  vomica  are  the  same  as  by  strychnia,  we  may 
pass  at  once  to  the  consideration  of  the  latter — merely 
mentioning  that  thirty  grains  of  nux  vomica,  about  the 
weight  of  one  seed,  and  three  grains  of  the  alcoholic  ex- 
tract have  proved  fatal.1  Strychnia  is  not  ouly  used  medici- 
nally, but  is  readily  obtainable  otherwise,  entering  largely 
into  the  composition  of  the  so-called  "  vermin-killers," 
Battley's  vermin-killer  containing  as  much  as  23  per  cent. 

The  first  symptoms  of  strychnia  poisoning,  appearing 
usually  within  from  ten  to  twenty  minutes  after  it  is  taken, 
are  a  general  uneasiness  and  restlessness,  followed  by  a 
feeling  of  suffocation.  The  muscles  begin  to  twitch  and 
the  head  and  limbs  to  jerk,  and  then  violent  tetanic  con- 
vulsions come  on,  involving  the  whole  body.  The  legs 
are  stretched  out  stiffly  and  separated,  the  feet  arched 
and  turned  in,  the  arms  are  flexed  and  drawn  across  the 
chest.  The  head  and  body  are  so  bent  back  that  opis- 
1  Christison  :  op.  cit.,  p.  201. 


232  A    MANUAL   OP 

thotonos  supervenes,  the  patient  resting  upon  his  head  and 
heels.  The  respiratory  movements  are  arrested  by  the 
muscular  spasm,  the  face  becomes  livid,  the  pupils  dilated. 
The  muscles  of  the  mouth  are  so  contracted  as  to  give  rise 
to  a  broad  grin,  the  risus  sardonicus,  and  lockjaw  is  fre- 
quently present,  though  one  of  the  later  symptoms.  In- 
tense thirst  may  be  experienced.  The  paroxysm  may  last 
from  half  a  minute  to  several  minutes;  subsiding,  it  is 
followed  by  relaxation,  the  patient  being  bathed  in  perspi- 
ration and  utterly  prostrated.  In  a  short  time,  sometimes 
within  a  few  minutes,  the  paroxysm  returns,  being 
brought  on  by  the  slightest  cause — a  breath  of  wind,  a 
slight  noise,  an  effort  to  move.  It  increases  in  frequency 
and  violence;  death  results  usually  in  between  five  and 
six  hours  from  asphyxia  or  exhaustion,  the  mind  remain- 
ing clear  almost  to  the  last.  As  small  a  quantity  as  the 
one-sixteenth  of  a  grain  of  strychnia  has  proved  fatal 
in  a  child,  and  one-half  of  a  grain  in  an  adult.1  It 
should  be  mentioned  that  the  action  of  strychnia,  when 
administered  hypodermatically,  is  far  more  powerful  than 
when  given  by  the  mouth.  In  the  treatment  of  strychnia 
poisoning,  emetics  should  be  given  at  once,  and  the 
stomach-pump  used  if  the  lockjaw  permits  of  it.  Lock- 
jaw can  sometimes  be  overcome  by  chloroform,  the  ad- 
ministration of  which  is  often  attended  in  other  respects 
with  good  results.  The  thirst  can  be  relieved  by  strong 
tea  better  than  by  anything  else.  Calabar  bean,  on  account 
of  being  a  spinal  depressant,  should  be  tried  ;  and  bromide 
of  potassium  in  large  doses,  morphia,  atropia,  chloral 
hydrate,  nitrite  of  amyl  may  also  prove  efficacious  as 
antidotes. 

On  post-mortem  examination  the  brain  and  spinal  cord 
1  Taylor :  op.  cit.,  p.  217. 


MEDICAL  JTJEISPRtTDENCE   AND  TOXICOLOGY.      233 

may  be  found  very  much  congested,  with  effusion  of  blood. 
Rigor  mortis  may  be  prolonged  for  several  weeks  after 
death.  In  extracting  strychnia  from  the  stomach  the 
organic  mixture  should  be  first  acidified  with  acetic  acid, 
and  sufficiently  diluted  to  make  filtering  easy.  The  fil- 
trate, having  been  evaporated  to  the  consistency  of  a  syrup, 
should  be  then  heated  with  eight  or  ten  times  its  bulk  of 
alcohol,  and  again  filtered,  the  liquid  being  distilled  off. 
The  filtrate  should  then  be  saturated  with  liquor  potassse 
and  shaken  up  with  its  own  bulk  of  ether.  The  acetate 
of  strychnia,  previously  formed,  being  now  decomposed  by 
the  potassa,  the  strychnia  is  precipitated  and  is  taken  up 
by  the  ether.  Any  coloring-matter  present  may  be  re- 
moved by  sulphuric  acid.  In  order  to  insure  the  perfect 
purity  of  the  strychnia  the  above  process  should  be  re- 
peated two  or  three  times.  Strychnia  may  be  recognized 
by  its  bitter  taste,  by  the  tetanic  convulsions  that  it  pro- 
duces when  injected  subcutaneously  into  a  frog,  and  by  the 
play  of  colors  it  exhibits  in  the  presence  of  nascent  oxygen. 
It  is  probably  the  bitterest  substance  known.  Indeed,  only 
one  grain  gives  a  bitter  taste  to  a  gallon  or  even  more 
of  water.  In  the  absence,  therefore,  of  such  substances 
as  morphia,  quinia,  aloes,  colocynth,  quassia,  characterized 
also  by  having  a  bitter  taste,  a  substance  possessing  this 
quality  and  alleged  to  have  caused  death  should  certainly 
be  tested  still  further  for  strychnia.  The  delicacy  of  the 
physiological  test,  that  is,  of  causing  convulsions  in  a  frog 
by  the  subcutaneous  injection  of  strychnia,  may  be  appre- 
ciated from  the  fact  that  convulsions  follow  the  injection 

of  only  T"soUU*u  Par^  °^  a  gram> 

The  color  test  is  performed  by  adding  a  drop  of  pure 
sulphuric  acid  to  a  small  piece  of  strychnia  on  a  white  por- 
celain surface,  the  strychnia,  if  perfectly  pure,  being  dis- 


234 


A   MANUAL  OF 


solved  by  the  acid  without  coloration.  If  a  little  bichro- 
mate of  potassium,  or  binoxide  of  manganese,  be  now 
stirred  into  the  mixture,  a  play  of  colors  will  be  presented, 
succeeding  each  other  in  the  following  order — blue,  violet, 
purple,  pink,  and  finally  red.  It  should  be  observed  that 
the  value  of  the  color  test  depends  not  so  much  upon  any 
particular  color  being  developed,  or  upon  there  being  a  play 
of  colors,  as  upon  the  constant  order  in  which  the  differ- 
ent colors  manifest  themselves.  The  color  test  is  even 
more  delicate  than  the  physiological  one,  the  TooooTo^h 
of  a  grain  of  strychnia  having  been  detected  in  this  way. 
It  should  be  mentioned,  however,  that  it  has  been  objected 
that  there  are  certain  substances,  like  morphia,  which  in- 
terfere with  the  color  test,  and  that  there  are  other  sub- 
stances which  exhibit  very  much  the  same  play  of  colors 
on  the  addition  of  sulphuric  acid.  In  reply,  it  may  be 
said  that  those  substances  which  interfere  with  the  color 
test  can  be  gotten  rid  of  by  using  chloroform  instead  of 
ether  in  extracting  the  alkaloid  from  the  stomach,  and  that 


Fig.  49. 


Fig.  50. 


Various  forms  of  crystals  of  strychnia. 


Crystals  of  brucia. 


the  change  of  color  manifested  by  strychnia  differs  so  much 
from  that  exhibited  by  other  bodies  on  the  addition  of  sul- 


MEDICAL  JURISPRUDENCE    AND   TOXICOLOGY.      235 


phuric  acid  that  no  real  difficulty  should  be  experienced 
in  distinguishing  them  (Fig.  49). 

Brucia  (Fig.  50),  the  remaining  alkaloid  of  mix  vom- 
ica, is  usually  found  associated  with  strychnia.  As  the 
symptoms  of  brucia  are  the  same  as  those  of  strychnia, 
only  less  intense,  and  as  the  mode  of  extraction  from  the 
stomach  is  the  same  in  the  case  of  both  alkaloids,  we  need 
not  dwell  upon  its  special  properties.  It  may  be  men- 
tioned, however,  that  it  turns  to  a  blood-red  color  in  the 
presence  of  nitric  acid,  the  alkaloid  being  speedily  dissolved. 

Cerebrospinal  Neurotic  Poisons. — Poisoning  by  Bella- 
donna.— Belladonna  may  be  considered  as  the  type  of 
a  group  of  poisons  the  characteristic  effects  of  which  are 
frequently  flushed  face,  redness  of  the  skin,  heat  and  dry- 
ness of  the  throat,  dilatation  of  the  pupil,  illusion  of  the 
senses,  and  active  delirium. 
Indeed,  the  latter  symptom  Fig.  51. 

is  so  characteristic  of  these 
poisons  that  the  entire  group 
is  often  designated  on  that 
account  as  "  deliriauts."  The 
group  includes  stramonium, 
hyoscyamus,  different  species 
of  solanum  as  well  as  bella- 
donna, all  representatives  of 
the  natural  order  of  Solanaceae, 
and  known  therapeutically  as 
mydriatics.  The  symptoms 
of  poisoning  by  belladonna, 
the  Atropa  belladonna  (Fig. 
51)  or  deadly  nightshade,  ap- 
pearing usually  within  two  hours  of  taking  the  substance, 
are  giddiness,  drowsiness,  intense  thirst,  dryness  of  the 


Atropa  belladonna :  a,  the  berry. 


236  A   MANUAL   OF 

mouth  and  throat,  difficulty  in  swallowing,  the  saliva  being 
suppressed.  Vomiting  and  purging  are  rare.  The  action 
of  the  heart  is  increased,  pulse  rapid  and  strong.  The  face 
is  flushed,  the  eyes  sparkle,  with  pupils  invariably  dilated. 
The  power  of  speech  is  lost,  though  there  is  a  constant 
movement  of  the  lips  and  tongue,  as  if  the  patient  was 
trying  to  articulate.  Vision  is  affected,  if  not  lost,  through 
the  loss  of  the  power  of  accommodation.  There  is  frequently 
a  desire  to  micturate,  with  inability  to  do  so.  The  patient 
is  affected  with  all  kinds  of  illusions  and  hallucinations, 
and  finally  with  delirium,  which  in  some  cases  may  be  of 
a  pleasing  character,  in  others  so  furious  as  to  resemble 
mania.  Death,  when  it  occurs,  takes  place  usually  within 
twenty-four  hours.  A  few  berries  of  belladonna  or  a 
drachm  of  the  extract  has  proved  fatal.1  The  symptoms 
of  poisoning  by  atropia,  the  active  alkaloid  of  belladonna, 
are  the  same  as  those  of  the  plant  itself — only  manifesting 
themselves  more  quickly  and  acting  more  powerfully.  One 
and  a  half  grains  of  atropia  have  proved  fatal.2 

In  treating  cases  of  poisoning  by  belladonna  or  atropia 
the  stomach  should  be  evacuated  by  an  emetic  or  by  means 
of  the  stomach-pump.  Morphia  should  be  administered 
hypodermatically.  As  soon  as  the  patient  shows  signs  of 
getting  better,  castor  oil  may  be  given  and  strong  coffee. 
The  post-mortem  appearances  presented  in  cases  of  poison- 
ing by  atropia  or  belladonna  are  neither  constant  nor  well 
marked.  The  pupils  are  dilated.  The  brain  may  be  con- 
gested and  the  stomach  inflamed.  In  cases  of  poisoning 
from  belladonna,  the  remains  of  the  leaves  and  berries 
should  be  carefully  searched  for  in  the  stomach  and  intes- 
tines.    Atropia  can  be  extracted    from   the  stomach  by 

1  Woodman  and  Tidy:  op.  cit.,  p.  210. 

2  Wharton  and  Stille :  op.  cit.,  p.  423. 


MEDICAL   JURISPRUDENCE   AND   TOXICOLOGY.      237 


acidifying;  the  contents  of  the  latter  with  acetic  acid  and 
warm  alcohol  and  filtering.  The  filtrate  .should  then  be 
treated  with  snbacetate  of  lead  and  sulphuretted  hydrogen, 
by  which  the  sulphide  of  lead  is  precipitated.  The  clear 
filtrate  evaporated  to  dryness  and  acidified,  and  saturated 
with  potassa,  can  be  then  treated  with  alcohol,  and  the 
extract  tested.  A  solution  of  hydrobromie  acid  saturated 
with  free  bromine  gives  a  yellow  precipitate  which  soon 
becomes  crystalline,  and  is  insoluble  in  mineral  acids,  acetic 
acid,  or  caustic  alkalies.  Atropia  can  also  be  tested  by 
applying  a  portion  of  the  ultimate  extract  to  the  eye  of  a 
man  or  of  a  rabbit,  the  smallest  quantity  producing  dilata- 
tion of  the  pupil.  As  the  symptoms,  treatment,  etc.  of 
poisoning  by  stramonium  or  thornapple,  Jamestown  weed, 
hyoseyamus  or  henbane,  solanum  dulcamara  or  bittersweet, 
woody  nightshade,  are  essen- 
tially the  same  as  those  of  Fig.  52. 
belladonna,  it  will  be  un- 
necessary to  dwell  especially 
upon  them. 

Poisoning  by  Tobacco. — 
Among  the  cerebro  -  spinal 
neurotic  poisons  are  tobacco, 
lobelia  (Fig.  52),  conia,  aco- 
nite, Calabar  bean,  often  con- 
sidered together  on  account  of 
the  property  they  possess  in 
common  of  depressing  the 
muscular  system,  although 
they  may  differ  from  one  an- 
other in  some  respects.  Tobacco,  or  the  dried  leaves  of  Xico- 
tiana  tabacum,  owes  its  active  and  poisonous  properties  to  a 


Lobelia  iuflata. 


238  A   MANUAL   OF 

volatile  liquid  alkaloid,  nicotina,1  one  of  the  most  rapidly 
fatal  poisons  known,  existing  in  Havana  tobacco  to  an  ex- 
tent of  only  two  per  cent.,  but  in  Kentucky  and  Virginia 
tobaccos  to  as  much  as  seven  per  cent.  The  symptoms  of 
poisoning  by  tobacco  are  giddiness,  much  depression  and 
faintness,  trembling  of  the  limbs,  clammy  sweats,  frequent 
vomiting,  violent  abdominal  pains,  with  occasional  purg- 
ing. The  pulse  becomes  first  weak  and  then  almost  im- 
perceptible ;  breathing  becomes  difficult ;  vision  is  affected ; 
death  taking  place  with  convulsions  and  more  or  less 
paralysis.  In  treating  cases  of  poisoning  by  tobacco,  the 
stomach  should  be  evacuated  as  soon  as  possible,  either  by 
emetics  or  the  stomach-pump.  Pain  may  be  relieved  by 
opium  and  the  strength  should  be  supported  by  stimulants. 
The  external  application  of  tobacco  leaves  and  of  a  decoc- 
tion of  tobacco  to  the  skin,  as  well  as  half  a  drachm  given 
by  enema,  has  proved  fatal.  Death  has  resulted  from 
tobacco  within  fifteen  minutes  and  from  nicotina  in  three 
minutes. 

On  post-mortem  examination  the  stomach,  liver,  lungs, 
and  brain  may  be  found  congested,  but  not  invariably. 
The  remains  of  tobacco  should  be  looked  for  with  a  lens. 
The  hairs  found  on  the  pieces  are  peculiar.  In  extracting 
tobacco  from  the  stomach  essentially  the  same  process  may 
be  used  as  that  described  in  obtaining  belladonna.  A  con- 
venient test  for  nicotina  is  corrosive  sublimate,  which 
yields  a  white  crystalline  precipitate,  soon  changing  to 
yellow,  and  soluble  in  acetic  and  hydrochloric  acids.  As  the 
symptoms  and  post-mortem  appearances  caused  by  Indian 
tobacco,  lobelia  inflata  or  its  active  alkaloid  lobelina,  are 
very  much  the  same  as  those  due  to  the  taking  of  ordinary 
tobacco,  it  will  be  unnecessary  to  describe  them.  It  may 
1  Tardieu :  op.  cit.,  p.  778. 


MEDICAL   JURISPRUDENCE    AM)    TOXICOLOGY.      239 


bo  mentioned,  however,  that  one  drachm  of  the  powdered 
leaves  has  proved  fatal  in  about  thirty-six  hours.  On 
post-mortem  examination  the  brain  was  found  congested 
and  the  mucous  membrane  of  the  stomach  inflamed. 

Poisoning  by  conia,  the  active  alkaloid  of  the  spotted 
hemlock  (Convum  maculatum;  Fig.  53),  is  generally  the  re- 


Fig.  53. 


Fig.  54. 


Conium  maculatum :  a,  the  fruit ; 
b,  transverse  section  of  the  fruit. 


Aconitum  napellus  (aconite) : 
a,  the  root ;  b,  the  leaf. 


suit  of  accident,  the  fresh  leaves  being  sometimes  used  in  cook- 
ing in  mistake  for  parsley,  which  it  slightly  resembles.  The 
symptoms  are  dryness  and  constriction  of  the  throat,  mus- 
cular prostration,  pupils  often  dilated  and  vision  affected, 
paralysis,  and  frequently  convulsions,  delirium,  and  coma. 
The  post-mortem  appearances  presented  are  those  of  as- 


240  A    MANUAL   OF 

phyxia,  congestion  of  the  brain,  and  inflammation  of  the 
mucous  membrane  of  the  stomach.  The  treatment  should 
consist  in  the  administration  of  emetics,  diffusible  stimu- 
lants, and  in  practising  artificial  respiration. 

Poisoning  by  Aconite. — The  symptoms  of  poisoning  by 
aconite,  obtained  from  monkshood  or  wolfbane  (Aconitum 
napettus;  Fig.  54),  are  dryness  of  the  throat,  with  tingling 
and  numbness  of  the  lips  and  tongue,  followed  by  nausea  and 
vomiting  and  abdominal  pain.  There  are  ringing  in  the  ears 
and  diminishing,  if  not  loss  of,  vision.  The  power  of  speech  is 
lost.  Breathing  becomes  slow  and  laborious.  Cold,  clammy 
sweats  are  common,  accompanied  with  great  prostration. 
The  numbness  of  the  limbs  increases  until  finally  both  ex- 
tremities are  paralyzed.  Death  occurs  either  from  shock, 
asphyxia,  or  syncope.  Aconitia,  the  active  alkaloid  of 
aconite,  is  probably  the  most  powerful  poison  known.  In 
treating  cases  of  poisoning  by  aconite  or  its  active  principle, 
an  emetic  of  sulphate  of  zinc  should  be  administered  at 
once,  or  the  stomach-pump  used.  Mustard  plasters  may 
be  applied  to  the  pit  of  the  stomach  ;  and  ammonia,  brandy, 
strong  tea,  or  coffee  should  be  given.  Digitalis  should 
be  tried  as  an  antidote.  Twenty-five  minims  of  Flemiug's 
tincture  and  one-tenth  of  a  grain  of  aconite  have  proved 
fatal.1  Death  generally  takes  place  within  three  or  four 
hours ;  though  it  has  occurred  within  twenty  minutes,  it 
has  been  delayed  nearly  twenty  hours. 

On  post-mortem  examination  there  is  usually  found 
general  venous  congestion,  especially  of  the  brain,  liver, 
and  lungs,  as  well  as  inflammation  of  the  mucous  mem- 
brane of  the  alimentary  canal.  The  different  parts  of  the 
plant  should  be  carefully  looked  for.  The  process  of  ex- 
traction from  the  stomach  is  essentially  the  same  as  that 
1  Taylor :  op.  cit.,  p.  226;  Gny  and  Ferrier:  op.  cit.,  p.  621. 


MEDICAL   JURISPRUDENCE    AND   TOXICOLOGY.      241 

described  for  obtaining  belladonna.  The  characteristic 
symptoms  produced  when  given  to  small  animals,  such  as 
weakness,  staggering',  difficult  breathing,  convulsive  twitch- 
ings,  loss  of  sensibility,  etc.,  constitute  the  most  important 
tests  for  aconitia.  Iodide  of  potassium  may  also  be  used 
as  a  test,  giving  with  the  alkaloid  a  reddish-brown  amor- 
phous precipitate. 

Calabar  bean,  the  seed  of  Physostir/ma  vencnosum,  owes 
its  poisonous  properties  to  an  alkaloid,  physostigma,  or 
eseriue.  The  symptoms  of  poisoning  are  giddiness,  fol- 
lowed by  paralysis  of  the  voluntary  muscles,  convulsive 
muscular  twitch ings,  and  invariably  contraction  of  the 
pupil.  Owing  to  the  latter  property,  atropia  should  be 
administered  as  an  antidote.  Six  of  the  beans  proved 
fatal  in  the  case  of  a  boy  who  had  eaten  them.1 

The  cerebro-spinal  neurotic  poisons  include  not  only  the 
deliriant  and  depressant  kind  of  poisons,  but  also  such  as 
usually  destroy  life  by  causing  heart  failure,  and  hence 
often  called  "asthenics."  The  most  important  of  this  kind 
of  poisons  are  hydrocyanic  acid,  digitalis,  and  cocculus 
indicus. 

Poisoning  by  Hydrocyanic  Acid. — Hydrocyanic  or  prussic 
acid  is  one  of  the  most  powerful  and  rapidly  fatal  poisons 
known,  its  effects  being  manifested  with  lightning-like 
rapidity.  It  is  developed  rather  than  pre-exists  in  the 
kernels  of  the  peach,  apricot,  plum,  cherry,  and  in  the 
leaves  and  flowers  of  the  peach  and  cherry-laurel  through 
the  action  of  water  upon  amygdalin  and  emulsin,  two 
principles  present  in  the  plants.  Pure  prussic  acid,  being 
rarely  found  anywhere  except  in  the  laboratory  of  the 
chemist,  has  but  little  or  no  interest  medico-legal ly.  The 
medicinal  acid,  or  the  solution  of  the  pure  anhydrous  acid 

1  Woodman  and  Tidy  :  op.  eit. ,  p.  320. 

1(3 


242  A    MANUAL    OF 

in  water,  demands  attention,  however,  on  account  of  death 
being  so  frequently  caused  by  it. 

The  symptoms  produced  by  prussic-acid  poisoning  are 
giddiness,  with  immediate  loss  of  muscular  power,  the 
person  staggering  and  falling  to  the  ground.  The  breath- 
ing becomes  quick  and  gasping,  the  pulse  imperceptible. 
The  eyes  protrude  and  are  glassy,  the  pupils  being  dilated 
and  insensible  to  light.  The  extremities  are  cold.  The 
face  becomes  livid  or  pale.  The  jaws  are  spasmodically 
closed.  There  may  be  bloody  frothing  at  the  mouth,  and 
the  odor  of  the  poison  may  be  noticed  on  the  breath. 
Death  may  take  place  preceded  by  coma,  stertorous  breath- 
ing, or  by  convulsions.  Unfortunately,  the  poisonous 
effects  of  prussic  acid  manifest  themselves  so  quickly  that 
the  opportunity  is  but  rarely  afforded  for  treatment.  The 
latter,  when  practicable,  consists  in  applying  cold  affu- 
sions, practising  artificial  respiration,  placing  ammonia  to 
the  nostrils.  A  mixture  of  a  ferrous  and  ferric  sulphate  of 
iron  with  caustic  alkali  should  be  administered  with  the 
hope  of  forming  the  inert  ferrocyanide  of  potassium. 
Emetics  and  the  stomach-pump  should  also  be  used.  On 
post-mortem  examination  the  lungs,  liver,  spleen,  and 
kidneys  will  be  found  gorged  with  blood.  The  brain 
may  be  found  congested,  and  there  may  be  effusion  of 
serum  into  the  ventricles.  The  stomach  and  intestines 
may  also  be  found  congested.  The  most  important,  con- 
stant, and  characteristic  sign  noticed,  however,  is  the  dis- 
tinct odor  of  prussic  acid  exhaled  when  the  body  is  opened 
and  often  even  before  it  is  opened.  Fifty  minims  of  the 
official  acid,  equivalent  to  about  nine-tenths  of  a  grain  of 
the  anhydrous  acid,  have  proved  fatal.1  Death  may  occur 
either  instantaneously  or  within  ten  or  fifteen  minutes  after 
1  Woodman  and  Tidy :  op.  cit.,  p.  457. 


MEDICAL  JUBISPBUDENCE    AND  TOXICOLOGY.      243 


Fig.  55. 


swallowing  the   poison,  being   rarely  protracted  half  an 
hour. 

The  general  method  adopted  in  extracting  prussic  acid 
from  the  stomach  is  to  distil  the  contents  of  the  latter  at  a 
gentle  heat,  the  vapor  being  collected  in  a  receiver  kept 
cool  by  being  placed  in  cold  water,  or  to  acidify  the  con- 
tents of  the  stomach  if  alkaline,  and  place  the  mixture  in 
a  vessel  standing  in  a  basin  containing  water  at  60°  F., 
and  then  testing  the  rising  vapor.  The  presence  of  prussic 
acid  can  be  recognized  by  the  white  cyanide  of  silver 
formed  through  application  of  nitrate  of  silver,  by  the 
white  sulphocyanide  of  ammonium  formed  with  sulphide 
of  ammonium,  the  latter  turning  red  on  the  addition  of 
perchloride  of  iron,  the  formation  of  Prussian  blue  by  add- 
ing liquor  potassse,  a  proto- 
and  per-salt  of  iron,  and  sul- 
phuric acid.  As  the  symp- 
toms, etc.  of  poisoning  by 
the  cyanides,  oil  of  bitter 
almonds,  cherry-laurel  water, 
the  kernels  of  the  peach,  apri- 
cot, and  cherry,  essence  of 
mirbaue,  are  essentially  the 
same  as  those  produced  by 
prussic  acid  proper,  only  less 
intense,  they  need  not  be  es- 
pecially considered. 

Poisoning  by  Digitalis. — 
The  symptoms  of  poisoning 
by  foxglove  (Digitalis  purpu- 
rea; Fig.  55),  or  its  active 
alkaloid  digitaline,  are  headache,  giddiness,  nausea,  vomit- 
ing, purging,  abdominal  pain,  dimuess  of  vision  with  dilated 


Digitalis  purpurea  leaf. 


244  A   MANUAL   OF 

pupils,  slow,  irregular  pulse.  In  treating  cases  of  poisoning 
by  digitalis  emetics  should  be  given,  and  infusions  containing 
tannin,  such  as  tea,  coffee,  oak  bark,  etc.,  as  stimulants.  On 
post-mortem  examination  the  brain  may  be  found  con- 
gested, and  the  mucous  membrane  of  the  stomach  inflamed. 
Digitalis  may  be  extracted  from  the  stomach  by  the  process 
used  in  obtaining  belladonna.  The  most  reliable  test  for 
digitaline  is  the  effect  it  produces  upon  the  action  of  the 
frog's  heart,  causing  stoppage  and  irregularity  in  the  beats. 

Poisoning  by  Cocculus  Indicus. — The  symptoms  of  poi- 
soning by  Cocculus  indicus,  or  the  berry  of  menispermum,  or 
Anamirta  cocculus,  are  gastro-intestinal  irritation,  accom- 
panied with  lethargic  stupor  and  powerlessness.  The 
poisonous  properties  are  due  to  an  alkaloid,  picrotoxine. 
Of  six  persons  poisoned  accidentally  on  one  occasion  by  a 
decoction  of  cocculus  indicus,  two  died  within  half  an 
hour,  the  remaining  four  recovering  after  several  hours. 
The  prominent  symptoms  in  these  cases  were  giddiness, 
faintness,  nausea,  dimness  of  vision,  intense  thirst,  and 
abdominal  pain.1 

In  conclusion,  it  may  be  mentioned  that  the  laburnum 
(Qytisus  laburnum),  the  yew  (Taxus  baccata),  the  privet 
(Legistrum  vulgare),  the  Guelder  rose  ( Viburnum  opulus), 
and  the  holly  (Ilex  aquifolium)  possess  acrid,  irritant,  nar- 
cotic properties  even  when  eaten  in  small  quantities. 
1  Wharton  and  Stille :  op.  eit.,  vol.  ii.  p.  499. 


INDEX. 


A. 

Abdomen,  enlargement  of,  108 

wounds  of,  GO 
Abortion,  criminal,  116 

feigned,  129 

from  natural  causes,  128 

means  employed,  127 

proofs  of,  116,  124 
Abortives,  128 
Acetate  of  lead,  214 
Acetic  acid,  219 
Aceto-arsenite  of  copper,  209 
Acid,  arsenic,  208,  209 

arsenious,  200 

carbolic,  219 

hydrochloric,  193 

hydrocyanic,  241 

meconic,  224 

nitric,  193 

oxalic,  218 

sulphuric,  193 

tartaric,  219 
Aconite,  poisoning  by,  240 
Aconitia,  240 
Aeon i turn  napellus,  239 
Adipocere,  33 
vEthusa  cynapium,  220 
Affiliation,  144 
After-birth,  121 
Age  deduced  from  teeth,  44 

for  legal  responsibility,  148 


Age  of  foetus,  121 

of  new-born  child,  46 

of  skeleton,  47 
Air,  influence  of,  on  putrefaction, 

30 
Alcohol,  poisoning  by,  227 
Alkalies,  poisoning  by,  194 
Amentia,  163 

Ammonia,  poisoning  by,  194 
Amorphous  phosphorus,  197 
Anaesthesia  in  rape,  103 
Anaesthetics,  poisoning  by,  228 
Analysis,  chemical,  187 
Animal  food,  noxious,  221 

irritants,  221 
Antagonism  of  poisons,  183 
Antimony,  poisoning  by,  209 
Apparent  death,  25 
Aqua  fortis,  194 
Areola  of  the  breasts,  109 
Arsenic,  antiseptic  power  of,  203 

poisoning  by,  200 
Arsenious  oxide,  200 
Arsenite  of  copper,  200,  209 
Arsenites,  209 

Arseniuretted  hydrogen,  206 
Artificial  inflation  of  lungs,  132 
Asphyxia,  varieties  of  death  by,  83 
Asthenia,  36 
Atropa  belladonna,  235 
Atropia,  poisoning  by,  235 
Auscultation  in  pregnancy,  111 
245 


246 


INDEX. 


B. 

Baby-farming,  92 
Ballottement  in  pregnancy,  110 
Balls,  apertures  made  by,  58 
Barium,  salts  of,  196 
Bean,  Calabar,  241 
Belladonna,  poisoning  by,  235 
Bestiality,  106 
Birth,  concealment  of,  137 

premature,  114,  116,  140 

proofs  of  a  live,  131 

protracted,  114,  139 
Bismuth,  poisoning  by,  217 
Bitter  almonds,  oil  of,  243 
Bittersweet,  poisoning  by,  237 
Bladder,  rupture  of,  60 
Blisters  from  burns  and  scalds,  82 
Blood,  animal  and  human,  72 
Blood,  coagulation  of,  78 
Blood-corpuscles,  human,  66 

measurement  of,  66 
Blood-crystals,  74 
Blood-stains,  examination  of,  62,  75 
Blows,  60 

Body,  putrefaction  of,  29 
Bones,  age  of,  47 

human  and  animal,  42 
identification  of,  42 
Born  alive,  meaning  of,  130,  140 
Brain,  injuries  of,  60 
Breasts,  change   of,  in  pregnancy, 

109 
Bromine,  poisoning  by,  199 
Brucia,  crystals  of,  234 

poisoning  by,  235 
Brunswick  green,  209 
Bullets,  deflection  of,  58 
Buoyancy  of  the  body,  88 
Burns  and  scalds,  81 
Butter  of  antimony,  211 


c. 

Cadaveric  alkaloids,  222 

lividity,  29 

rigidity,  27 

spasm,  28 
Cesarean  section,  143 
Calabar  bean,  241 
Caloricity,  post-mortem,  27 
Calvaria,  40 

Cantharides,  poisoning  by,  222 
Capacity,  testamentary,  173 
Carbolic  acid,  poisoning  by,  219 
Carbon  dioxide,  poisoning  by,  230 

monoxide,  poisoning  by,  230 
Castor-oil  beans,  poisoning  by,  221 
Catamenia,  suppression  of,  108 
Certificates  of  insanity,  172 
Cervix  uteri,  126 
Cheese,  poisoning  by,  223 
Chemical  analysis,  187 
Cherry-laurel  water,  243 
Chest,  examination  of,  in  cases  of 
infanticide,  132 

wounds  of,  60 
Child-murder,  130-138 
Ch  loral  hydrate,  poisoning  by,  229 
Chloride  of  antimony,  211 
Chloroform,  poisoning  by,  229 
Cholera  mistaken  for  poisoning,  185 
Chorion,  117 

villous  processes  of,  120 
Chromium,  poisoning  by,  217 
Cicatrices,  indentification  by,  151 
Cicuta  virosa,  221 
Circulation,  cessation  of,  24 

foetal,  134 
Circumstantial  evidence  in  cases  of 

poisoning,  189 
Civil  responsibility,  161,  171 
Clothing,  stabs  in,  53 


INDEX. 


247 


Clothing,  stains  of,  02 

I  loagulation  of  the  blood,  78 

( locculus  indicus,  244 

Colchieum,  poisoning  by,  221 

Cold,  death  from,  93 

Coldness  of  the  body  in  death,  26 

Colic,  painter's,  215 

Coma,  death  by,  35 

Compensation  of  medical  witnesses, 

20 
Concealment  of  birth,  137 

of  habits  in  life  insurance,  156 

of  pregnancy,  107 
Conception,  date  of,  113 
Concussion  of  brain,  60 
Conia,  239 

Conium  maculatum,  239 
Contracts  to  cure,  157 
Contused  wounds,  55 
Contusions  on  the  living  and  the 

dead,  55 
Cooling  of  body  after  death,  26 
Copper,  poisoning  by,  216 
Cord,  mark  of,  in  hanging,  84 
in  strangulation,  84 

umbilical,  in  foetus,  122 
Coroner,  office  of,  23 
Coroner's  inquest,  21 

physician,  19 
Corpus  luteum,  112 
Corrosive  sublimate,  211 
Cotton,  fibres  of,  53 
Courtesy,  tenancy  by,  143 
Cowbane,  poisoning  by,  221 
Cranium,  fractures  of,  60 
Crimes,  unnatural,  106 
Criminal  abortion,  116 

responsibility,  161,  172,  175 
Cross-examination,  49 
Croton  oil,  poisoning  by,  220 
Crying,  evidences  from,  140 


Cry  psorch  ides,  141 
Cyanides,  poisoning  by,  242 

( lytisus  laburnum,  244 

I>. 

Date  of  conception,  113 
Dead  body,  examination  of,  24 
Death  certificate,  21,  24 

phenomena  and  signs  of,  24 

presumption  of,  149 

varieties  of,  35 
Decidua  vera,  reflexa,  and  serotina, 

119,  120 
Declarations,  dying,  50 
Deformities,  identification  by,  48, 

151 
Delivery,  concealed,  137 

premature,  140 

signs  of,  136 
Delusions,  176 
Dementia,  170 
Development  of  foetus,  116-121 

of  generative  organs,  146 
De  ventre  inspiciendo,  107 
Diaphragm,  position  of,  132 
Digitaline,  243 
Digitalis,  poisoning  by,  243 

purpurea,  243 
Dipsomania,  167 
Discharge  of  lunatics,  173 
Disease,  influence  of,  in  poisoning, 

1S4 
Diseased  flesh.  221 
Distance  at  which  persons  can  be 

seen,  151 
Divorce,  legal  grounds  for,  142 
Docimasia  circulations,  134 

pulmonum,  132 
Doubtful  sex,  145,  147 
Dress,  examination  of  the.  53,  151 
Dropwort,  poisoning  by,  221 


248 


INDEX. 


Drowning,  death  from,  87 

resuscitation  from,  89 

signs  of,  87 
Drunkards,  responsibility  of,  167, 

176 
Ductus  arteriosus,  134 

venosus,  135 
Dulcamara,  poisoning  by,  237 
Dying  declarations,  50 

E. 
Eccentricity  not  insanity,  173 
Eczema  from  arsenic-poisoning,  201 
Effusion  of  blood,  55 
Elaterium,  220 
Embryo,  human,  116 

changes  undergone  by,  121 
development  of,  116 
Emerald  green,  poisoning  by,  209 
Emetic,  tartar,  poisoning  by,  209 
Emphysema  of  the  lungs,  133 
Epilepsy,  feigned,  154 
Epispadias,  141 
Ergot,  128,  220 
Erysipelas,  60 
Eserine,  241 

Essence  of  mirbane,  243 
Ether,  poisoning  by,  228 
Evidence,  medical,  49 

of  poisoning,  186 
Examination,  cross-,  49 

in  chief,  49 

of  blood-stains,  62 

of  clothes,  53 

of  hairs,  53 

of  lunatics,  172 

of  weapons,  53 

of  wounds,  52 
Experts,  medical,  18 
Exposure,  death  from,  137 
Extra-uterine  conception,  129 


F. 

Face,  wounds  of,  60 

Family  likeness,  evidence  from,  151 

Farinaceous  substances  in  stomach 

of  infant,  136 
Fatality  in  wounds,  51 
Features,  evidence  from,  151 
Fees,  medical,  19,  20 
Feigned  abortion,  129 

bodily  diseases,  153 

deafness  and  dumbness,  154 

insanity,  177 

wounds,  154 
Fish,  diseased,  223 
Flax,  fibres  of,  53 
Flesh,  diseased,  221 
Foetal  circulation,  134 

sounds,  111 

vessels,  changes  in,  at  birth,  134 
Foeticide,  116 

determination  of,  125 

means  of  producing,  127 
Foetus,  development  of,  116 
Food,  poisonous,  221 
Fool's  parsley,  poisoning  by,  220 
Foramen  ovale,  134 
Forensic  medicine,  17 
Fowler's  solution,  200,  209 
Foxglove,  poisoning  by,  243 
Fractures,  identity  from,  48 

in  new-born  children,  137 
Frigidity  of  constitution,  143 
Fungi,  poisonous,  221 

G. 

Gases,  noxious,  poisoning  by,  196 
Gestation,  normal  period,  113 

premature,  114 

protracted,  113,  139 
Gonorrhoea  in  rape,  100 


INDEX. 


249 


Grand  jury,  48 

Gratuitous  practice,  161 

Guaiacum  test,  63 

Guelder  rose,  poisoning  by,  244 

Gunpowder,  wounds  from,  58 

Gunshot  wounds,  57 

H. 

Habit,  influence  of,  in  poisoning, 

184 
Habits,  concealment  of,  156 
Hrematin,  62 
Hsemoglobin,  62 
Hairs,  identification  of,  53 
Hallucinations,  176 
Hanging,  death  by,  85 

signs  of  death  by,  86 
Head,  wounds  of,  60 
Heart,  wounds  of,  60 
Heat,  cause  of  death  by,  93 

loss  of,  after  death,  26 
Hellebore,  poisoning  by,  221 
Hemlock,  poisoning  by,  239 
Hemorrhage  of  navel,  137 
Henbane,  poisoning  by,  237 
Heredity  in  insanity,  174 
Hermaphrodites,  145 
Hibernation,  25 
Holly,  poisoning  by,  244 
Homicidal  mania,  168 

wounds,  56 
Human  bones,  43 

hairs,  52 
Hydatids,  uterine,  124 
Hydrate  of  chloral,  229 
Hydrochloric  acid,  193 
Hydrocyanic  acid,  241 
Hydrostatic  test,  132 
Hymen,  evidence  from,  99,  105 
Hyoscyamus,  poisoning  by,  237 
Hypnotism,  relation  of,to  crime,  154 


I. 

Identification  of  the  dead,  42 

of  the  living,  150 
Idiocy,  163 

Idiosyncrasy  in  poisoning,  181 
Illusions,  176 
Imbecility,  163 
Impotence,  141 

Impregnation,  unconscious,  103 
Imputed  wounds,  153 
Incised  wounds,  54 
Indian  tobacco,  238 
Infant  born  dead,  proofs  of,  131 
Infanticide,  130 

means  of  committing,  137 

proofs  of  live  birth,  131 
Infantile  leucorrhcea,  100 
Inflation  of  lungs,  132 
Inheritance,  139 
Inquests,  coroners',  21 

medical  witnesses  at,  48 
Insanity,  162 

feigned,  177 

in  relation  to  life  insurance,  157 

medico-legal  relations,  162,  171 

puerperal,  169 

varieties  of,  162 
Insensibility  of  eyes  to  light  after 

death,  26 
Inspection  of  the  body,  38 
Insurance,  life,  155 
Intellectual  mania,  166 
Intemperance  in  relation  to  life  in- 
surance, 155 
Interments,  premature,  24 
Intestines,  wounds  of,  60 
Intoxication     distinguished    from 

concussion,  60 
Iodine,  poisoning  by,  199 
Irritant  poisons,  191,  192 


250 


INDEX. 


J. 

Jessamine,  221 
Juniperus  sabina,  221 
Jury  of  matrons,  107 

K. 

Kiesteine  in  the  urine,  110 
Kleptomania,  166 

L. 

Labor,  premature,  116 

Laburnum,  244 

Lacerated  wounds,  54 

Laudanum,  225 

Lead,  poisoning  by,  214 

Legal  medicine,  17 

Legitimacy,  139 

Leucorrhcea,  infantile,  100 

License  of  counsel,  49 

Life  insurance,  155 

Lightning,  death  from,  95 

Likeness,  parental,  144 

Linen,  microscopic  appearance,  53 

Live  birth,  130 

proofs  of,  132 
Liver,  wounds  of,  60 
Lividity,  cadaveric,  29 
Lobelia  inflata,  238 
Lobelina,  237 
Lochia,  137 
Lucid  intervals,  176 
Lungs,  emphysema  of,  133 

examination     of,    in     new-born 
children,  132 

wounds  of,  60 


M. 


Majority,  148 
Malpractice,  157 
Mania,  164 


Mania,  feigned,  179 

homicidal,  168 

intellectual,  166 

moral,  166 

puerperal,  169 

suicidal,  168 
Marks  of  blood,  39,  62 
Marsh's  test,  206 
Maternity,  early,  114 
Matrons,  jury  of,  107 
Measurement  of  blood-corpuscles, 

66 
Meconic  acid,  224 
Medical  evidence,  49 

experts,  18 

jurisprudence,  17 

malpractice,  157 

profession  and  the  coroner,  rela- 
tions of,  20 

registration,  160 

responsibility,  158 
Medico-legal  terms  defined,  176 
Melancholia,  165 
Membrana  pupillaris,  122 
Menstrual  blood,  79 
Menstruation,  108 
Mercuric  chloride,  211 
Mercury,  poisoning  by,  211 
Micrometer,  66 

Microscopic  examination  of  blood- 
stains, 64 
in  rape,  101 
Milk  in  stomach  of  infant,  136 
Mineral  acids,  poisoning  by,  192 
Miscarriage,  116 
Moles,  identification  by,  151 

uterine,  123 
Monkshood,  poisoning  by,  240 
Monomania,  168 
Monsters,  143 
Moral  mania,  166 


INDEX. 


25 1 


Morphia,  224 

Mortality  of  wounds,  58 
Mother,  examination  of,  124,  13G 
Motives  for  crime,  168,  189 
Miico-purulent  discharges,  100 
Muriatic  acid,  193 
Mushrooms,  poisoning  by,  221 
Mussels,  poisoning  by,  223 
Mutilated  bodies,  identification  of, 
42 

N. 
Nrevi,  identification  by,  151 
Neurotic  poisons,  192,  223 
Nicotina,  238 
Nitre,  death  from,  196 
Nitric  acid,  194 
Notes  of  autopsy,  38 
Nux  vomica,  poisoning  by,  231 
Nymphomania,  165 

O. 

(Enanthe  crocata,  221 
Oil  of  bitter  almonds,  243 

of  savin,  128,  221 

of  tansy,  128 
Opium,  poisoning  by,  224 
Organs  of  adults,  weights  of,  41 
Orpiment,  200 

Osmosis  of  poisons  after  death,  187 
Ossification-test  of  age  in  new-born 

child,  45,  115 
Ovum,  human,  140 
Oxalic  acid,  218 

P. 

Prederastia,  106 

Painter's  colic,  215 

Pallor  of  body  after  death,  26 

Palsy  from  lead,  215 

Papaver  somniferum,  224 


Paper-hangings,  arsenic  in,  209 
Paralysis,  feigned,  154 
Paralytic  dementia,  170 
Parental  likeness,  144 
Paresis  of  insane,  170 
Paris  green,  209 
Paternity,  144 
Personal  identity,  42,  150 
Phosphorus,  poisoning  by,  197 
Placenta,  118,  121 
Plea  of  pregnancy,  107 
Poisoned  flesh,  222 
Poisonous  food,  222 
Poisons,  absorption  of,  182 

definition,  181 

elimination  of,  182 

evidences  of,  184 

examination  for,  185 

mode  of  action,  182 

post-mortem  imbibition  of,  187 
Policy,  life-insurance,  155 
Post-mortem  examination,  38 
Potassium   oxalate,   poisoning   by, 
218 

salts,  poisoning  by,  194 
Pregnancy,  107 

concealed,  107 

duration  of,  113 

feigned,  107 

in  the  dead,  115 

precocious,  114 

signs  of,  107 

unconscious,  115 
Premature  burials,  24 

labor,  116 
Presumption  of  death,  149 
Privet,  poisoning  by,  244 
Procreative  power,  142 
Protracted  gestation,  113,  139 
Prussic  acid,  242 
Ptomaines,  222 


252 


INDEX. 


Puberty,  141 
Puerperal  mania,  169 
Punctured  wounds,  54 
Purulent  discharges,  99 
Putrefaction,  29 

conditions  modifying,  26 

order  of,  32 
Putrescent  food,  222 
Pyromania,  167 

Q. 

Quickening,  109 

K. 

Rape,  anaesthesia  in,  104 

definition,  97 

on  adults,  97,  103 

on  children,  97 

on  the  dead,  105 

on  the  insane,  97 
Red  phosphorus,  197 
Re-examination,  49 
Reinsch's  test,  208 
Respiration,  131 

a  sign  of  life,  134 

cessation  of,  24 
Responsibility,  civil  and  criminal, 
171 

medical,  158 
Rigidity,  cadaveric,  27 
Rigor  mortis,  27 

S. 
Saccharine  substance   in   stomach 

of  infant,  136 
Salivation,  mercurial,  212,  214 
Salt  of  lemons,  218 

of  sorrel,  218 
Saturnine  poisoning,  215 
Satyriasis,  165 
Sausage,  poisoning  by,  222 


Savin,  oil  of,  128 
Scalds  and  burns,  81 
Scalp,  wounds  of,  60 
Scars,  identification  by,  151 
Scheele's  green,  200,  209 
Schweinfurt's  green,  209 
Self-inflicted  wounds,  55 
Seminal  stains,  101 
Sex,  determination  of,  147 

doubtful,  145,  147 
Sexual  malformation,  141 
Shock,  death  from,  59 
Shot,  wounds  made  by,  57 
Signs  of  deatl),  24 
Silk,  microscopic  appearance,  54 
Skeletons,  age  of,  44 

date  of  interment,  48 

identification  from,  48 

sex  of,  44 

stature  of,  48 
Skull,  identification  from,  43 
Sleep,  influence  of,   in  poisoning, 

184 
Smothering,  death  by,  83 
Soda  and  its  salts,  194 
Sodomy,  106 
Softening  of  stomach  in  poisoning, 

186 
Solanum  dulcamara,  237 
Somnambulism,  168 
Sorrel,  salt  of,  218 
Sound,  velocity  of,  151 
Specific  gravity  of  lungs,  132 
Spectral  analysis,  75 
Spermatozoa,  101 
Spine,  concussion  of,  GO 
Starch,  detection  of,  in  stomach  of 

infant,  136 
Starvation,  death  by,  92 
Sterility,  142 
Still-births,  131 


INDEX. 


25.' 


Stomach,  mode  of  examination  of 
186 

redness  of,  in  poisoning,  186 

ulceration  of,  180 

wounds  of,  60 
Stramonium,  poisoning  by,  237 
Strangulation,  death  by,  84 

signs  of,  84 
Strychnia,  crystals  of,  234 
Strychnine,  poisoning  by,  231 
Sublimate,  corrosive,  211 
Subnitrale  of  bismuth,  217 
Subpoenas,  18,  23 
Sudden  death,  20 
Suffocation,  death  by,  83 

of  new-born  children,  83 
Sugar,  detection  of,  in  stomach  of 

infant,  136 
Suggillation,  29 
Suicidal  mania,  168 

wounds,  55 
Sulphide  of  arsenic,  200 
Sulphuric  acid,  193 
Sunstroke,  93 
Su  perforation,  145 
Surgical  operations,  death  from,  60 
Survivorship,  140,  149 
Syncope,  35 

T. 

Tartar  emetic,  209 
Tartaric  acid,  219 
Tattoo  marks,  identification  by,  151 
Teeth  a  test  for  age,  44 
Tenancy  by  courtesy,  143 
Testamentary  capacity,  173 
Tetanus  from  wounds,  59 
Time  elapsing  since  death,  33 
Tin,  poisoning  by,  21S 
Tobacco,  poisoning  by,  237 
Toxicology,  180 


Trichina  spiralis,  223 
Trichinosis,  222 
Trichomonas  vaginalis,  101 

U. 

Ulceration  and  corrosion  in  poison- 
ing, 186 
Umbilical  cord,  condition  of,  in  live 

and  dead-born  children,  135 
insertion  of,  122 
Unconscious  pregnancy,  115 
Unnatural  crimes,  106 
Uterine  sounds,  111 
Uterus,  changes  of,  in  pregnancy, 
108,  110,  126 
normal  unimpregnated,  125 
putrefaction  of,  115 

V. 

Vagina,  dilatation  of,  in  rape  of 
children,  99 
wounds  of,  125 
Vaginitis,  104 
Vegetable  irritants,  218 
Ventre  de  inspiciendo,  107 
Veratrum  viride,  poisoning  by,  221 
Verdigris,  216 
Vertebra?,  fractures  of,  86 
Viability  of  the  child,  116,  140 
Vienna  green,  209 
Virginity,  signs  of,  99,  105 
Voice,  identification  by,  151 
Vulval  penetration,  97 

W. 

Wadding,  wounds  by,  58 
Wall-papers,  arsenical,  209 
Water,  influence  of,  on  putrefaction. 

29 
Weapons,     connection     of,     with 

wounds,  52 


254 


INDEX. 


Wedlock,  born  in,  142,  143 
Weight  of  new-born  child,  122 
White  hellebore,  221 

lead,  poisoning  by,  215 
Wills,  capacity  for  making,  173 
Witnesses,  ordinary  and  medical, 

17,  18 
Wounds,  cause  of  death  by,  58 

definition  of,  51 

from  gunpowder,  57 

made    before    and   after   death, 
55 


Wounds  on  different  parts  of  body, 
60 
on  new-born  children,  138 
self-inflicted,  55 
variety  of,  55 

Y. 

Yellow  arsenic,  200 
Yew,  poisoning  by,  244 

Z. 

Zinc,  poisoning  by,  217 


Catalogue    the    Medical     Publications 


W.   B.  SAUNDERS   &   COMPANY 

PHILADELPHIA       **        j*        j*        Jt        j*  LONDON 

925  Walnut  Street    Jt        Jt        <£        £        jt    161  Strand,  W.  C. 

Arranged  Alphabetically  and  Classified  under  Subjects 
See  page  18  for  a  List  of  Contents  classified  according  to  subjects 

THK  books  advertised  in  this  Catalogue  as  being  sold  by  subscription  are  usually  to  be 
obtained  from  travelling  solicitors,  but  they  will  be  sent  direct  from  the  office  of  pub- 
lication (charges  of  shipment  prepaid)  upon  receipt  of  the  prices  given.     All  the  other 
books  advertised  are  commonly  for  sale  by  booksellers  in  all  parts  of  the  United  States;  but 
books  will  be  sent  to  any  address,  carriage  prepaid,  on  receipt  of  the  published  price. 

Money  may  be  sent  at  the  risk  of  the  publisher  in  either  of  the  following  ways  :  A  postal 
money  order,  an  express  money  order,  a  bank  check,  and  in  a  registered  letter.  Money 
sent  in  any  other  way  is  at  the  risk  of    the  sender. 

SPECIAL  To  physicians  of  approved  credit  books  will  be  sent,  post-paid,  on  the  following 
OFFER  terms  :  #5.00  cash  upon  delivery  of  books,  and  monthly  payments  of  j?5.oo  there- 
after until  full  amount  is  paid.  Any  one  or  two  volumes  will  be  sent  on  thirty  days'  time 
to  those  who  do  not  care  to  make  a  larger  purchase. 


AN  AMERICAN  TEXT=BOOK  OF  APPLIED  THERAPEUTICS. 

Edited  by  James  C.  Wilson,  M.  D.,  Professor  of  Practice  of  Medicine  and 
of  Clinical  Medicine,  Jefferson  Medical  College,  Philadelphia.  Handsome 
imperial  octavo  volume  of  1326  pages.  Illustrated.  Cloth,  $7.00  net; 
Sheep  or  Half  Morocco,  $8.00  net.     Sold  by  Subscription. 

AN  AMERICAN  TEXT=BOOK  OF  THE   DISEASES  OF  CHIL= 
DREN.     Second  Edition,  Revised. 

Edited  by  Louis  Starr,  M.  D.,  Consulting  Pediatrist  to  the  Maternity  Hos- 
pital, etc.  ;  assisted  by  THOMPSON  S.  WESTCOTT,  M.  D.,  Attending  Phvsi- 
cian  to  the  Dispensary  for  Diseases  of  Children,  Hospital  of  the  University 
of  Pennsylvania.  Handsome  imperial  octavo  volume  of  1244  pages,  pro- 
fusely illustrated.  Cloth,  $7.00  net ;  Sheep  or  Half  Morocco,  $8.00  net. 
Sold  by  Subscription. 

AN  AMERICAN   TEXT=BOOK  OF   DISEASES  OF  THE   EYE, 
EAR,  NOSE,  AND  THROAT. 

Edited  by  G.  E.  DE  SCHWEINITZ,  M.  D..  Professor  of  Ophthalmology, 
Jefferson  Medical  College,  Philadelphia  ;  and  B.  Alexander  Randall, 
M.  D.,  Clinical  Professor  of  Diseases  of  the  Ear,  University  of  Pennsylvania. 
Imperial  octavo,  1251  pages;  766  illustrations,  59  of  them  in  colors.  Cloth, 
$7.00  net ;  Sheep  or  Haif  Morocco,  SS.00  net.     Sold  by  Subscription, 


MEDICAL    PUBLICATIONS 


AN    AMERICAN    TEXT=BOOK    OF    GENITOURINARY    AND 
SKIN  DISEASES. 

Edited  by  L.  Bolton  Bangs,  M.  D.,  Professor  of  Genito-Urinary  Surgery, 
University  and  Bellevue  Hospital  Medical  College,  New  York  ;  and  W.  A. 
Hardaway,  M.  D.,  Professor  of  Diseases  of  the  Skin,  Missouri  Medical 
College.  Imperial  octavo  volume  of  1229  pages,  with  300  engravings  and 
20  full-page  colored  plates.  Cloth,  $7.00  net ;  Sheep  or  Half  Morocco, 
$8:00  net.     Sold  by  Subscription. 

AN    AMERICAN   TEXT=BOOK  OF   GYNECOLOGY,   MEDICAL 
AND  SURGICAL.    Second  Edition,  Revised. 

Edited  by  J.  M.  BALDY,  M.  D.,  Professor  of  Gynecology,  Philadelphia 
Polyclinic,  etc.  Handsome  imperial  octavo  volume  of  718  pages;  341  illus- 
trations in  the  text,  and  38  colored  and  half-tone  plates.  Cloth,  $6.00  net ; 
Sheep  or  Half  Morocco,  $7.00  net.     Sold  by  Subscription. 

AN    AMERICAN    TEXT=BOOK  OF    LEGAL    MEDICINE    AND 
TOXICOLOGY. 

Edited  by  FREDERICK  PETERSON,  M.  D.,  Chief  of  Clinic,  Nervous  Depart- 
ment, College  of  Physicians  and  Surgeons,  New  York  ;  and  WALTER  S. 
Haines,  M.  D.,  Professor  of  Chemistry,  Pharmacy,  and  Toxicology,  Rush 
Medical  College,  Chicago.     In  Preparation. 

AN  AMERICAN  TEXT=BOOK  OF  OBSTETRICS. 

Edited  by  RICHARD  C.  NORRIS,  M.  D.  ;  Art  Editor,  Robert  L.  DICKINSON, 
M.  D.  Handsome  imperial  octavo  volume  ©f  1014  pages  ;  nearly  900  beau- 
tiful colored  and  half-tone  illustrations.  Cloth,  $7.00  net ;  Sheep  or  Half 
Morocco,  $8.00  net.     Sold  by  Subscription. 

AN  AMERICAN  TEXT-BOOK  OF  PATHOLOGY. 

Edited  by  LUDWIG  Hektoen,  M.  D.,  Professor  of  Pathology  in  Rush 
Medical  College,  Chicago  ;  and  David  Riesman,  M.  D.,  Demonstrator  of 
Pathologic  Histology  in  the  University  of  Pennsylvania.  Handsome  im- 
perial octavo,  over  1200  pages,  profusely  illustrated.     By  Subscription. 

AN  AMERICAN  TEXT=BOOK  OF  PHYSIOLOGY.    Second  Edi= 
tion,  Revised,  in  Two  Volumes. 

Edited  by  William  H.  Howell,  Ph.  D.,  M.  D.,  Professor  of  Physiology, 
Johns  Hopkins  University,  Baltimore,  Md.  Two  royal  octavo  volumes  of 
about  600  pages  each.  Fully  illustrated.  Per  volume:  Cloth,  $3.00  net; 
Sheep  or  Half  Morocco,  $3-75  net. 

AN  AMERICAN  TEXT=BOOK  OF  SURGERY.    Third  Edition. 

Edited  by  WILLIAM  W.  KEEN,  M.  D.,  LL.D.,  F.  R.  C.  S.  (Hon.);  and 
J.  William  WHITE,  M.  D.,  Ph.  D.  Handsome  octavo  volume  of  1230 
pages  ;  496  wood-cuts  and  37  colored  and  half-tone  plates.  Thoroughly 
revised  and  enlarged,  with  a  section  devoted  to  "The  Use  of  the  Ront- 
gen  Rays  in  Surgery."  Cloth,  $7.00  net ;  Sheep  or  Half  Morocco, 
$8.00  net, 


OF  W.   B.   SAUNDERS  &>  CO. 


THE  NEW   STANDARD  THE   NEW   STANDARD 

THE    AMERICAN    ILLUSTRATED    MEDICAL     DICTIONARY. 
Second  Edition,  Revised. 

For  Practitioners  and  Students.  A  Complete  Dictionary  of  the  Terms  used 
in  Medicine,  Surgery,  Dentistry,  Pharmacy,  Chemistry,  and  tin- kindred 
branches,  including  much  collateral  information  of  an  encyclopedic  charai  ter, 
together  with  new  and  elaborate  tables  of  Arteries,  Muscles,  Nerves,  Veins, 
etc. ;  of  Bacilli,  Bacteria,  Micrococci,  Streptococci  ;  Eponymic  Tables  of 
Diseases,  Operations,  Signs  and  Symptoms,  Stains,  Tests,  Methods  of  Treat- 
ment, etc.,  etc.  By  W.  A.  Newman  Dorland,  A.  M.,  M.  D.,  Editor 
of  the  "  American  Pocket  Medical  Dictionary."  Handsome  large  octavo, 
nearly  800  pages,  bound  in  full  flexible  leather.  Price,  $4.50  net ;  with 
thumb  index,  $5.00  net. 

Gives  a  Maximum  Amount  of  Matter  in  a  Minimum  Space  and  at  the  Lowest 

Possible  Cost. 

This  Revised  Edition  contains  all  the  Latest  Terms. 

"  1  'r.ust  acknowledge  my  astonishment  at  seeing  how  much  he  has  condensed  within 
relatively  sum"  space.  I  find  nothing  to  criticise,  very  much  to  commend,  and  was  in- 
terested in  fin  ling  some  of  the  new  words  which  are  not  in  other  recent  dictionaries." — 
Ruswell  Park,  Professor  of  Principles  and  Practice  of  Surgery  and  Clinical  Surgery, 
University  of  Buffalo. 

"  I  congratulate  you  upon  giving  to  the  profession  a  dictionary  so  compact  in  its  structure, 
and  so  replete  with  information  required  by  the  busy  practitioner  and  student.  It  is  a 
necessity  as  well  as  an  informed  companion  to  every  doctor.  It  should  be  upon  the  desk 
of  every  practitioner  and  student  of  medicine."— John  B.  Murphy,  Professor  of  Surgery 
and  Clinical  Surgery,  Northwestern  University  Medical  School,  Chicago. 

THE  AMERICAN    POCKET    MEDICAL    DICTIONARY.    Third 
Edition,  Revised. 

Edited  by  W.  A.  Newman  Dorland.,  M.  D.,  Assistant  Obstetrician  to  the 
Hospital  of  the  University  of  Pennsylvania ;  Fellow  of  the  American  Acad- 
emy of  Medicine.  Containing  the  pronunciation  and  definition  of  the  prin- 
cipal words  used  in  medicine  and  kindred  sciences,  with  64  extensive  tables. 
Handsomely  bound  in  flexible  leather,  with  gold  edges.  Price  $1.00  net; 
with  thumb  index,  $1.25  net. 

THE  AMERICAN  YEAR=BOOK  OF  MEDICINE  AND  SURGERY. 

A  Yearly  Digest  of  Scientific  Progress  and  Authoritative  Opinion  in  all 
branches  of  Medicine  and  Surgery,  drawn  from  journals,  monographs,  and 
text-books  of  the  leading  American  and  Foreign  authors  and  investigators. 
Arranged  with  editorial  comments,  by  eminent  American  specialists,  under 
the  editorial  charge  of  George  M.  Gould,  M.  D.  Year-Book  of  1901 
in  two  volumes — Vol.  I.  including  General  Medicine  ;  Vol.  II.,  General  Sur- 
gery. Per  volume  :  Cloth,  $3.00  net ;  Half  Morocco,  $3.75  net.  Sold  by  Sub- 
scription. 

ABBOTT  ON   TRANSMISSIBLE  DISEASES.     Second   Edition, 
Revised. 

The  Hygiene  of  Transmissible  Diseases:  their  Causation,  Modesof  Dissem- 
ination, and  Methods  of  Prevention.  By  A.  C.  Abbott,  M.  D.,  Professor 
of  Hygiene  and  Bacteriology,  University  of  Pennsylvania.  Octavo,  351 
pages,  with  numerous  illustrations.     Cloth,  $2.50  net. 


MEDICAL   PUBLICATIONS 


ANDERS'  PRACTICE  OF  MEDICINE.     Fifth  Revised  Edition. 

A  Text-Book  of  the  Practice  of  Medicine.  By  JAMES  M.  ANDERS,  M.  D., 
PH.  D.,  LL.  D.,  Professor  of  the  Practice  of  Medicine  and  of  Clinical  Med- 
icine', Medico-Chirurgical  College,  Philadelphia.  Handsome  octavo  volume 
of  1292  pages,  fully  illustrated.  Cloth,  $5.50  net;  Sheep  or  Half  Morocco, 
$6.50  net. 

BASTIN'S  BOTANY. 

Laboratory  Exercises  in  Botany.  By  Edson  S.  Bastin,  M.  A.,  late  Pro- 
fessor of  Materia  Medica  and  Botany,  Philadelphia  College  of  Pharmacy. 
Octavo,  536  pages,  with  87  plates.     Cloth,  $2.00  net. 

BECK  ON  FRACTURES. 

Fractures.  By  Carl  Beck,  M.  D.,  Surgeon  to  St.  Mark's  Hospital  and 
the  New  York  German  Poliklinik,  etc.  With  an  appendix  on  the  Practical 
Use  of  the  Ronlgen  Rays.     335  pages,  170  illustrations.     Cloth,  $3.50  net. 

BECK'S  SURGICAL   ASEPSIS. 

A  Manual  of  Surgical  Asepsis.  By  Carl  Beck,  M.  D.,  Surgeon  to  St. 
Mark's  Hospital  and  the  New  York  German  Poliklinik,  etc.  306  pages;  65 
text-illustrations  and  12  full-page  plates.     Cloth,  $1.25  net. 

BOISLINIERE'S    OBSTETRIC    ACCIDENTS,    EMERGENCIES, 
AND  OPERATIONS. 

Obstetric  Accidents,  Emergencies,  and  Operations.  By  L.  Ch.  BOISLIN- 
IERE,  M.  D.,  late  Emeritus  Professor  of  Obstetrics,  St.  Louis  Medical  Col- 
lege.    381  pages,  handsomely  illustrated.     Cloth,  $2.00  net. 

BOHM,   DAVIDOFF,   AND   HUBER'S   HISTOLOGY. 

A  Text-Book  of  Human  Histology.  Including  Microscopic  Technic.  By 
Dr.  A.  A.  Bohm  and  Dr.  M.  VON  DAVIDOFF,  of  Munich,  and  G.  Carl 
HUBER,  M.  D.,  Junior  Professor  of  Anatomy  and  Director  of  Histological 
Laboratory,  University  of  Michigan.  Handsome  octavo  of  501  pages,  with 
351  beautiful  original  illustrations.     Cloth,  $3.50  net. 

BUTLER'S      MATERIA      MEDICA,      THERAPEUTICS,     AND 
PHARMACOLOGY.    Third  Edition,  Revised. 

A  Text-Book  of  Materia  Medica,  Therapeutics,  and  Pharmacology.  By 
George  F.  Butler,  Ph.  G,  M.  D.,  Professor  of  Materia  Medica  and  of 
Clinical  Medicine,  College  of  Physicians  and  Surgeons,  Chicago.  Octavo, 
874  pages,  illustrated.    Cloth,  $4.00  net ;  Sheep  or  Half  Morocco,  $5.00  net. 

CERNA    ON    THE    NEWER     REMEDIES.       Second     Edition, 
Revised. 

Notes  on  the  Newer  Remedies,  their  Therapeutic  Applications  and  Modes 
of  Administration.  By  David  Cerna,  M.  D.,  Ph.  D.,  Demonstrator  of 
Physiology,  Medical  Department,  University  of  Texas.  Rewritten  and 
greatly  enlarged.     Post-octavo,  253  pages.     Cloth,  $1.00  net. 


OF   IV.   />'.  SAUNDERS  &>   CO. 


CHAPIN  ON  INSANITY. 

A  Compendium  of  Insanity.  By  John  li.  CHAPIN,  M.I).,  LL.D.,  Phy- 
sician-in-Chief,  Pennsylvania  Hospital  fur  (he  Insane;  Honorary  Membei 
of  the   Medico-Psychological  Society  of  Great    Britain,  of  the  Society  of 

Mental  Medicine  of  Belgium,  etc.  121110,  234  pages,  illustrated.  Cloth, 
#1.25  net. 

CHAPMAN'S  MEDICAL  JURISPRUDENCE  AND  TOXICOLOGY. 
Second  Edition,  Revised. 

Medical  Jurisprudence  and  Toxicology.  Py  HENRY  C.  CHAPMAN,  M.  D., 
Professor  of  Institutes  of  Medicine  and  Medical  Jurisprudence,  Jefferson 
Medical  College  of  Philadelphia.  254  pages,  with  55  illustrations  and  3 
full-page  plates  in  colors.     Cloth,  #1.50  net. 

CHURCH  AND  PETERSON'S  NERVOUS  AND  MENTAL  DIS= 

EASES.     Third  Edition,  Revised  and  Enlarged. 

Nervous  and  Mental  Diseases.  By  Archibald  Church,  M.  D.,  Pro- 
fessor of  Nervous  and  Mental  Diseases,  and  Head  of  the  Neurological 
Department,  Northwestern  University  Medical  School,  Chicago;  and 
Frederick  Peterson,  M.  D.,  Chief  of  Clinic,  Nervous  Department,  Col- 
lege of  Physicians  and  Surgeons,  New  York.  Handsome  octavo  volume  of 
875  pages,  profusely  illustrated.  Cloth,  #5.00  net ;  Sheep  or  Half  Morocco, 
#6.00  net. 

CLARKSON'S  HISTOLOGY. 

A  Text-Book  of  Histology,  Descriptive  and  Practical.  By  Arthur  Clark- 
SON,  M.  B.,  C  M.  Edin.,  formerly  Demonstrator  of  Physiologv  in  the  Owen's 
College,  Manchester  ;  late  Demonstrator  of  Physiology  in  Yorkshire  College, 
Leeds.  Large  octavo,  554  pages  ;  22  engravings  and  174  beautifully  colored 
original  illustrations.     Cloth,  #4.00  net. 

CORWIN'S  PHYSICAL  DIAGNOSIS.    Third  Edition,  Revised. 

Essentials  of  Physical  Diagnosis  of  the  Thorax.  By  Arthur  M.  Corwix, 
A.  M.,  M.  D.,  Instructor  in  Physical  Diagnosis  in  Rush  Medical  College, 
Chicago.     219  pages,  illustrated.     Cloth,  #1.25  net. 

CROOKSHANK'S   BACTERIOLOGY.     Fourth  Edition,  Revised. 

A  Text-Book  of  Bacteriology.  By  Edgar  M.  Crookshank.  M.  B.,  Pro- 
fessor of  Comparative  Pathology  and  Bacteriology,  King's  College,  London. 
Octavo,  700  pages,  273  engravings  and  22  original  colored  plates.  Cloth, 
#6.50  net ;   Half  Morocco,  $7.50  net. 

DACOSTA'S  SURGERY.    Third  Edition,  Revised. 

Modern  Surgery,  General  and  Operative.  By  John  Chalmers  DaCosta, 
M.  D.,  Professor  of  Principles  of  Surgery  and  Clinical  Surgery,  Jefferson 
Medical  College,  Philadelphia  ;  Surgeon  to  the  Philadelphia  Hospital,  etc. 
Handsome  octavo  volume  of  1117  pages,  profusely  illustrated.  Cloth.  55.00 
net ;  Sheep  or  Half  Morocco,  S6.00  net. 

Enlarged  by  over  200  Pages,  with  more  than  100  New  Illus- 
trations. 


MEDICAL   PUBLICATIONS 


DAVIS'S  OBSTETRIC  NURSING. 

Obstetric  and  Gynecologic  Nursing.  By  Edward  P.  Davis,  A.  M.,  M.  D., 
Professor  of  Obstetrics  in  Jefferson  Medical  College  and  the  Philadelphia 
Polyclinic ;  Obstetrician  and  Gynecologist  to  the  Philadelphia  Hospital. 
i2ino  volume  of  400  pages,  fully  illustrated.     Crushed  buckram,  $1.75  net. 

DE  SCHWEINITZ  ON  DISEASES  OF  THE  EYE.    Third   Edi= 
tion,  Revised. 

Diseases  of  the  Eye.  A  Handbook  of  Ophthalmic  Practice.  By  G.  E. 
DE  SCHWEINITZ,  M.  D.,  Professor  of  Ophthalmology,  Jefferson  Medical 
College,  Philadelphia,  etc.  Handsome  royal  octavo  volume  of  696  pages ; 
256  fine  illustrations  and  2  chromo-lithographic  plates.  Cloth,  $4.00  net ; 
Sheep  or  Half  Morocco,  $5.00  net. 

DORLAND'S  DICTIONARIES. 

[See  American  Illustrated  Medical  Dictionary  and  American 
Pocket  Medical  Dictionary  on  page  3.] 

DORLAND'S    OBSTETRICS.      Second     Edition,    Revised    and 
Greatly  Enlarged. 

Modern  Obstetrics.  By  W.  A.  NEWMAN  DORLAND,  M.  D.,  Assistant 
Demonstrator  of  Obstetrics,  University  of  Pennsylvania  ;  Associate  in  Gyne- 
cology, Philadelphia  Polyclinic.  Octavo  volume  of  797  pages,  with  201 
illustrations.     Cloth,  $4.00  net. 

EICHHORST'S  PRACTICE  OF  MEDICINE. 

A  Text-Book  of  the  Practice  of  Medicine.  By  Dr.  Herman  Eichhorst, 
Professor  of  Special  Pathology  and  Therapeutics  and  Director  of  the  Medi- 
cal Clinic,  University  of  Zurich.  Translated  and  edited  by  AUGUSTUS  A. 
ESHNER,  M.  D.,  Professor  of  Clinical  Medicine,  Philadelphia  Polyclinic. 
Two  royal  octavo  volumes,  600  pages  each,  150  illustrations.  Per  set : 
Cloth,  $6.00  net;  Sheep  or  Half  Morocco,  $7.50  net. 

FRIEDRICH  AND  CURTIS  ON  THE  NOSE,  THROAT,  AND 
EAR. 

Rhinology,  Laryngology,  and  Otology,  and  their  Significance  in  General 
Medicine.  By  Dr.  E.  P.  Friedrich,  of  Leipzig.  Edited  by  H.  Holbrook 
Curtis,  M.  D.,  Consulting  Surgeon  to  the  New  York  Nose  and  Throat  Hos- 
pital.    Octavo,  348  pages.     Cloth,  $2.50  net. 

FROTHINGHAM'S  GUIDE  FOR  THE  BACTERIOLOGIST. 

Laboratory  Guide  for  the  Bacteriologist.  By  Langdon  Frothingham, 
M.  D.  V.,  Assistant  in  Bacteriology  and  Veterinary  Science,  Sheffield  Scien- 
tific School,  Yale  University.     Illustrated.     Cloth,  75  cts.  net. 

GARRIGUES'   DISEASES   OF   WOMEN.    Third  Edition,  Re= 
vised. 

Diseases  of  Women.  By  Henry  J.  Garrigues,  A.  M.,  M.  D.,  Gynecolo- 
gist to  St.  Mark's  Hospital  and  to  the  German  Dispensary,  New  York  City. 
Octavo,  756  pages,  with  367  engravings  and  colored  plates.  Cloth,  $4.50 
net ;  Sheep  or  Half  Morocco,  $5.50  net. 


OF  IV.   />'.   SAUNDERS  &•  CO. 


GOULD  AND  PYLE'S  CURIOSITIES  OF  MEDICINE. 

Anomalies  and  Curiosities  of  Medicine.  By  George  M.  Gould,  M.  D., 
and  WALTER  L.  PYLE,  M.D.  An  encyclopedic  collection  of  rare  and  ex- 
traordinary  cases  and  of  the  most  striking  instances  of  abnormality  in  all 
branches  of  Medicine  and  Surgery,  derived  from  an  exhaustive  research  o\ 
medical  literature  from  iis  origin  to  the  present  day,  abstracted,  classified, 
annotated,  and  indexed.  Handsome  octavo  volume  of  968  pages ;  295  en- 
gravings and  12  full-page  plates.  Popular  Edition.  Cloth,  #3.00  net ;  Sheep 
or  Half  Morocco,  #4.00  net. 

GRAFSTROM'S  MECHANOTHERAPY. 

A  Text-Book  of  Meehano-Therapv  (Massage  and  Medical  Gymnastics). 
By  AxelV.  GRAFSTROM,  B.  Sc,  M.  D.,  late  House  Physician,  City  Hos- 
pital, Blackwell's  Island,  New  York.  i2mo,  139  pages,  illustrated.  Cloth, 
#1.00  net. 

GRIFFITH  ON  THE  BABY.     Second  Edition,  Revised. 

The  Care  of  the  Baby.  By  J.  P.  Crozer  Griffith,  M.  D.,  Clinical  Pro- 
fessor of  Diseases  of  Children,  University  of  Pennsylvania  ;  Physician  to  the 
Children's  Hospital,  Philadelphia,  etc.  i2mo,  404  pages,  67  illustrations 
and  5  plates.     Cloth,  $1.50  net. 

GRIFFITH'S  WEIGHT  CHART. 

Infant's  Weight-  Chart.  Designed  by  J.  P.  CROZER  GRIFFITH,  M.  D., 
Clinical  Professor  of  Diseases  of  Children,  University  of  Pennsylvania.  25 
charts  in  each  pad.     Per  pad,  50  cts.  net. 

HART'S  DIET  IN  SICKNESS  AND  IN  HEALTH. 

Diet  in  Sickness  and  Health.  By  Mrs.  Ernest  Hart,  formerly  Student 
of  the  Faculty  of  Medicine  of  Paris  and  of  the  London  School  of  Medicine 
for  Women  ;  with  an  Introduction  by  SIR  HENRY  THOMPSON,  F.  R.  C.  S., 
M.  D.,  London.     220  pages.     Cloth,  $1.50  net. 

HAYNES'   ANATOMY. 

A  Manual  of  Anatomy.  By  IRVING  S.  HAYNES,  M.  D.,  Professor  of  Prac- 
tical Anatomy  in  Cornell  University  Medical  College.  680  pages ;  42  dia- 
grams and  134  full-page  half-tone  illustrations  from  original  photographs  of 
the  author's  dissections.     Cloth,  $2.50  net. 

HEISLER'S  EMBRYOLOGY.     Second  Edition,  Revised. 

A  Text-Book  of  Embryology.  By  John  C.  Heisler,  M.  D.,  Professor  of 
Anatomy,  Medico-Chirurgical  College,  Philadelphia.  Octavo  volume  of  405 
pages,  handsomely  illustrated.     Cloth,  $2.50  net. 

HIRST'S  OBSTETRICS.     Third  Edition,  Revised  and  Enlarged. 

A  Text-Book  of  Obstetrics.  By  BARTON  COOKE  Hirst.  M.D.,  Professor 
of  Obstetrics,  University  of  Pennsylvania.  Handsome  octavo  volume  of 
873  pages,  704  illustrations,  36  of  them  in  colors.  Cloth,  S5.00  net ;  Sheep 
or  Half  Morocco,  $6.00  net. 


MEDICAL   PUBL1CA  TIONS 


HYDE  &  MONTGOMERY  ON  SYPHILIS  AND  THE  VENEREAL 
DISEASES.    2d  Edition,  Revised  and  Greatly  Enlarged. 

Syphilis  and  the  Venereal  Diseases.  By  James  Nevins  Hyde,  M.  D.,  Pro- 
fessor of  Skin  and  Venereal  Diseases,  and  Frank  H.  Montgomery,  M.  D., 
Associate  Professor  of  Skin,  Genito-Urinary,  and  Venereal  Diseases  in  Rush 
Medical  College,  Chicago,  111.  Octavo,  594  pages,  profusely  illustrated. 
Cloth,  $4.00  net. 

THE  INTERNATIONAL  TEXT=BOOK  OF  SURGERY.     In  Two 
Volumes. 

By  American  and  British  Authors.  Edited  by  J.  COLLINS  WARREN,  M.  D., 
LL.D.,  F.  R.C.  S.  (Hon.),  Professor  of  Surgery,  Harvard  Medical  School, 
Boston  ;  and  A.  PEARCE  GOULD,  M.  S.,  F.  R.  C.  S.,  Lecturer  on  Practical 
Surgery  and  Teacher  of  Operative  Surgery,  Middlesex  Hospital  Medical 
School,  London,  Eng.  Vol.  I.  General  Surgery. — Handsome  octavo,  947 
pages,  with  458  beautiful  illustrations  and  9  lithographic  plates.  Vol.  II. 
Special  or  Regiotial  Surgery. — Handsome  octavo,  1072  pages,  with  471 
beautiful  illustrations  and  8  lithographic  plates.  Sold  by  Subscription. 
Prices  per  volume  :  Cloth,  $5.00  net:  Sheep  or  Half  Morocco,  $6.00  net. 

"  It  is  the  most  valuable  work  on  the  subject  that  has  appeared  in  some  years.  The 
clinician  and  the  pathologist  have  joined  hands  in  its  production,  and  the  result  must  be  a 
satisfaction  to  the  editors  as  it  is  a  gratification  to  the  conscientious  reader." — Annals  of 
Surgery. 

"  This  is  a  work  which  comes  to  us  on  its  own  intrinsic  merits.  Of  the  latter  it  has 
very  many.  The  arrangement  of  subjects  is  excellent,  and  their  treatment  by  the  different 
authors  is  equally  so.  What  is  especially  to  be  recommended  is  the  painstaking  endeavor 
of  each  writer  to  make  his  subject  clear  and  to  the  point.  To  this  end  particularly  is  the 
technique  of  operations  lucidly  described  in  all  necessary  detail.  And  withal  the  work  is  up 
to  date  in  a  very  remarkable  degree,  many  of  the  latest  operations  in  the  different  regional 
parts  of  the  body  being  given  in  full  details.  There  is  not  a  chapter  in  the  work  from  which 
the  reader  may  not  learn  something  new." — Medical  Record,  New  York. 

JACKSON'S  DISEASES  OF  THE  EYE. 

A  Manual  of  Diseases  of  the  Eye.  By  Edward  JACKSON,  A.M.,  M.  D., 
Emeritus  Professor  of  Diseases  of  the  Eye,  Philadelphia  Polyclinic  and  Col- 
lege for  Graduates  in  Medicine.  i2mo,  volume  of  535  pages,  with  178  illus- 
trations, mostly  from  drawings  by  the  author.     Cloth,  $2.50  net. 

KEATING'S  LIFE  INSURANCE. 

How  to  Examine  for  Life  Insurance.  By  JOHN  M.  KEATING,  M.  D.,  Fellow 
of  the  College  of  Physicians  of  Philadelphia  ;  Ex-President  of  the  Association 
of  Life  Insurance  Medical  Directors.  Royal  octavo,  211  pages.  With 
numerous  illustrations.     Cloth,  $2.00  net. 

KEEN  ON  THE  SURGERY  OF  TYPHOID  FEVER. 

The  Surgical  Complications  and  Sequels  of  Typhoid  Fever.  By  Wm.  W. 
Keen,  M.  D.,  LL.D.,  F,  R.  C.  S.  (Hon.),  Professor  of  the  Principles  of  Sur- 
gery and  of  Clinical  Surgery,  Jefferson  Medical  College,  Philadelphia,  etc. 
Octavo  volume  of  386  pages,  illustrated.     Cloth,  $3.00  net. 

KEEN'S  OPERATION  BLANK.     Second  Edition,  Revised  Form. 

An  Operation  Blank,  with  Lists  of  Instruments,  etc.  Required  in  Various 
Operations.  Prepared  by  W.  W.  Keen,  M.  D.,  LL.D.,  F.  R.  C.  S.  (Hon.), 
Professor  of  the  Principles  of  Surgery  and  of  Clinical  Surgery,  Jefferson 
Medical  College,  Philadelphia.     Price  per  pad,  of  50  blanks,  50  cts.  net. 


OF   W.   B.  SAUNDERS  &>   CO. 


KYLE  ON  THE  NOSE   AND  THROAT.     Second  Edition. 

Diseases  of  the  Nose  and  Throat.     By  D.  Braden  Kyle,  M.  D.,  Clinical 
Professor  of  Laryngology  and  Rhinology,  Jefferson  Medii  al  ( lollege,  Phila- 
delphia.   Octavo,  646  pages  ;  over  150  illustrations  and  6  lithographii   plati 
Cloth,  #4.00  net;  Sheep  or  Half  Morocco,  #5.00  net. 

LAINE'S  TEMPERATURE  CHART. 

Temperature  Chart.  Prepared  by  D.  T.  Laine,  M.  I).  Size  8x13% 
inches.  A  conveniently  arranged  Chart  for  recording  Temperature,  with 
columns  for  daily  amounts  of  Urinary  and  Fecal  Excretions,  Food,  Re- 
marks, etc.  On  the  back  of  each  chart  is  given  the  Brand  treatment  of 
Typhoid  Fever.     Price,  per  pad  of  25  charts,  50  cts.  net. 

LEVY,  KLEMPERER,  AND   ESHNER'S  CLINICAL  BACTERI= 

OLOGY. 

The  Elements  of  Clinical  Bacteriology.  By  Dr.  Ernst  Levy,  Professor 
in  the  University  of  Strasburg,  and  Dr.  FELIX  K.LEMPERER,  Privatdoceril 

in  the  University  of  Strasburg.  Translated  and  edited  by  Augustus  A. 
ESHNER,  M.  D.,  Professor  of  Clinical  Medicine,  Philadelphia  Polyclinic. 
Octavo,  440  pages,  fully  illustrated.     Cloth,  $2.50  net. 

LOCKWOOD'S    PRACTICE    OF    MEDICINE.     Second   Edition, 
Revised  and  Enlarged. 

A  Manual  of  the  Practice  of  Medicine.  By  George  Roe  LOCKWOOD, 
M.  D.,  Professor  of  Practice  in  the  Women's  Medical  College  of  the  New 
York  Infirmary,  etc. 

LONG'S  SYLLABUS  OF  GYNECOLOGY. 

A  Syllabus  of  Gynecology,  arranged  in  Conformity  with  "An  American 
Text-Book  of  Gynecology."  By  J.  W.  Long,  M.  D.,  Professor  of  Dis- 
eases of  Women  and  Children,  Medical  College  of  Virginia,  etc.  Cloth, 
interleaved,  $1.00  net. 

MACDONALD'S  SURGICAL   DIAGNOSIS   AND  TREATMENT. 

Surgical  Diagnosis  and  Treatment.  By  J.  W.  Macdonald,  M.  D.  Edin., 
F.  R.  C.  S.  Edin.,  Professor  of  Practice  of  Surgery  and  Clinical  Surgery, 
Hamline  University.  Handsome  octavo,  800  pages,  fully  illustrated.  Cloth, 
$5.00  net ;  Sheep  or  Half  Morocco,  $6.00  net. 

MALLORY   AND   WRIGHT'S  PATHOLOGICAL  TECHNIQUE. 
Second  Edition,  Revised  and  Enlarged. 

Pathological  Technique.  A  Practical  Manual  for  Laboratory  Work  in 
Pathology,  Bacteriology,  and  Morbid  Anatomy,  with  chapters  on  Post- 
Mortem  Technique  and  the  Performance  of  Autopsies.  By  Frank.  B. 
MALLORY,  A.M.,  M.  D.,  Assistant  Professor  of  Pathology,  Harvard  Uni- 
versity Medical  School,  Boston;  and  Tames  H.  Wright,  A.M..  M.D., 
Instructor  in  Pathology,  Harvard  University  Medical  School,  Boston. 

McFARLAND'S    PATHOGENIC    BACTERIA.      Third    Edition, 
increased   in  size  by   over   100  Pages. 

Text-Book  upon  the  Pathogenic  Bacteria.  By  JOSEPH  McFARLAND. 
M.D.,  Professor  of  Pathology  and  Bacteriology,  Medico-Chirurgical  Col- 
lege of  Philadelphia,  etc.  Octavo  volume  of  621  pages,  finely  illustrated. 
Cloth,  $3.25  net. 


MEDICAL    PUBLICATIONS 


MEIGS  ON  FEEDING  IN  INFANCY. 

Feeding  in  Early  Infancy.  By  Arthur  V.  Meigs,  M.  D.  Bound  in  limp 
cloth,  flush  edges,  25  cts.  net. 

MOORE'S  ORTHOPEDIC  SURGERY. 

A  Manual  of  Orthopedic  Surgery.  By  J  AMES  E.  MOORE,  M.  D.,  Professor 
of  Orthopedics  and  Adjunct  Professor  of  Clinical  Surgery,  University  of 
Minnesota,  College  of  Medicine  and  Surgery.  Octavo  volume  of  356  pages, 
handsomely  illustrated.     Cloth,  $2.50  net. 

MORTEN'S  NURSES'  DICTIONARY. 

Nurses'  Dictionary  of  Medical  Terms  and  Nursing  Treatment.  Containing 
Definitions  of  the  Principal  Medical  and  Nursing  Terms  and  Abbreviations  ; 
of  the  Instruments,  Drugs,  Diseases,  Accidents,  Treatments,  Operations, 
Foods,  Appliances,  etc.  encountered  in  the  ward  or  in  the  sick-room.  By 
Honnor  Morten,  author  of  "  How  to  Become  a  Nurse,"  etc.  i6mo,  140 
pages.     Cloth,  $1.00  net. 

NANCREDE'S  ANATOMY  AND  DISSECTION.    Fourth  Edition. 

Essentials  of  Anatomy  and  Manual  of  Practical  Dissection.  By  CHARLES 
B.  NANCREDE,  M.  D.,  LL.D.,  Professor  of  Surgery  and  of  Clinical  Surgery, 
University  of  Michigan,  Ann  Arbor.  Post-octavo,  500  pages,  with  full-page 
lithographic  plates  in  colors  and  nearly  200  illustrations.  Extra  Cloth  (or 
Oilcloth  for  dissection-room),  $2.00  net. 

NANCREDE'S  PRINCIPLES  OF  SURGERY. 

Lectures  on  the  Principles  of  Surgery.  By  CHARLES  B.  NANCREDE,  M.  D., 
LL.D,,  Professor  of  Surgery  and  of  Clinical  Surgery,  University  of  Michigan, 
Ann  Arbor.     Octavo,  398  pages,  illustrated.     Cloth,  $2.50  net. 

NORRIS'S    SYLLABUS    OF    OBSTETRICS.      Third    Edition, 
Revised. 

Syllabus  of  Obstetrical  Lectures  in  the  Medical  Department  of  the  University 
of  Pennsylvania.  By  RICHARD  C.  NORRIS,  A.M.,  M.D.,  Instructor  in 
Obstetrics  and  Lecturer  on  Clinical  and  Operative  Obstetrics,  University 
of  Pennsylvania.  Crown  octavo,  222  pages.  Cloth,  interleaved  for  notes, 
$2.00  net. 

OGDEN  ON  THE  URINE. 

Clinical  Examination  of  the  Urine  and  Urinary  Diagnosis.  A  Clinical  Guide 
for  the  Use  of  Practitioners  and  Students  of  Medicine  and  Surgery.  By  J. 
Bergen  OGDEN,  M.  D.,  Instructor  in  Chemistry,  Harvard  University  Med- 
ical School.  Handsome  octavo,  416  pages,  with  54  illustrations,  and  a  num- 
ber of  colored  plates.     Cloth,  $3.00  net. 

PENROSE'S  DISEASES  OF  WOMEN.  Fourth  Edition,  Revised. 

A  Text-Book  of  Diseases  of  Women.  By  CHARLES  B.  PENROSE,  M.  D., 
Ph.  D.,  formerly  Professor  of  Gynecology  in  the  University  of  Pennsylvania. 
Octavo  volume  of  538  pages,  handsomely  illustrated.     Cloth,  $3.75  net. 


OF  IV.  B.  SAUNDERS  &  CO. 


PRYOR-PELYIC  INFLAMMATIONS. 

The  Treatment  of  Pelvic  Inflammations  through  the  Vagina.  By  W.  R. 
PRYOR,  M.  D.,  Professor  of  Gynecology,  New  York  Polyclinic.  i2mo,  248 
panes,  handsomely  illustrated.     Cloth,  #2.00  net. 

PYE'S  BANDAGING. 

Elementary  Bandaging  and  Surgical  Dressing.  With  Directions  concerning 
the  Immediate  Treatment  of  Cases  of  Emergency.  By  WALTER  PYE, 
F.  R.  C.  S.,  late  Surgeon  to  St.  Mary's  Hospital,  London.  Small  i2mo, 
over  80  illustrations.     Cloth,  flexible  covers,  75  cts.  net. 

PYLE'S  PERSONAL  HYGIENE. 

A  Manual  of  Personal  Hygiene.  Proper  Living  upon  a  Physiologic  Basis. 
Edited  by  Walter  L.  Pyle,  M.  D.,  Assistant  Surgeon  to  the  Wills  Eye 
Hospital,  Philadelphia.  Octavo  volume  of  344  pages,  fully  illustrated. 
Cloth,  $i.$o  net. 

RAYMOND'S    PHYSIOLOGY.       Second    Edition,    Revised    and 
Greatly  Enlarged. 

A  Text-Book  of  Physiology.  By  Joseph  H.  Raymond,  A.  M.,  M.  D.,  Pro- 
fessor of  Physiology  and  Hygiene  and  Lecturer  on  Gynecology  in  the  Long 
Island  College  Hospital. 

SALINGER  AND  KALTEYER'S  MODERN  MEDICINE. 

Modern  Medicine.  By  JULIUS  L.  SALINGER,  M.D.,  Demonstrator  of 
Clinical  Medicine,  Jefferson  Medical  College  ;  and  F.  J.  Kalteyer,  M.  D., 
Assistant  Demonstrator  of  Clinical  Medicine,  Jefferson  Medical  College. 
Handsome  octavo,  801  pages,  illustrated.     Cloth,  $4.00  net. 

SAUNDBY'S  RENAL  AND  URINARY  DISEASES. 

Lectures  on  Renal  and  Urinary  Diseases.  By  ROBERT  SAUNDRY.  M.  D. 
Edin.,  Fellow  of  the  Royal  College  of  Physicians,  London,  and  of  the  Royal 
Medico-Chirurgical  Society  ;  Professor  of  Medicine  in  Mason  College,  Bir- 
mingham, etc.  Octavo,  434  pages,  with  numerous  illustrations  and  4  colored 
plates.     Cloth,  $2.50  net. 

SAUNDERS'  MEDICAL  HAND=ATLASES.    See  pp.  16  and  17. 

SAUNDERS'   POCKET   MEDICAL   FORMULARY.     Sixth   Edi= 
tion,  Revised. 

By  William  M.  Powell,  M.  D.,  author  of  "  Essentials  of  Diseases  of 
Children";  Member  of  Philadelphia  Pathological  Society.  Containing  1844 
formulae  from  the  best-known  authorities.  With  an  Appendix  containing 
Posological  Table,  Formulas  and  Doses  for  Hypodermic  Medication. 
Poisons  and  their  Antidotes,  Diameters  of  the  Female  Pelvis  and  Fetal 
Head,  Obstetrical  Table,  Diet  List  for  Various  Diseases,  Materials  and 
Drugs  used  in  Antiseptic  Surgery,  Treatment  of  Asphyxia  from  Drowning, 
Surgical  Remembrancer,  Tables  of  Incompatibles,  Eruptive  Fevers,  etc., 
etc.  Handsomely  bound  in  flexible  morocco,  with  side  index,  wallet,  and 
flap.     $2.00  net. 

SAUNDERS'  QUESTION=COMPENDS.     See  pages  14  and  15. 


MEDICAL  PUBLICATIONS 


SCUDDER'S  FRACTURES.     Second  Edition,  Revised. 

The  Treatment  of  Fractures.  By  Chas  L.  Scudder,  M.D.,  Assistant  in 
Clinical  and  Operative  Surgery,  Harvard  University  Medical  School.  Oc- 
tavo, 433  pages,  with  nearly  600  original  illustrations.  Polished  Buckram, 
$4.50  net ;  Half  Morocco,  $5.50  net. 

SENN'S  GENITOURINARY  TUBERCULOSIS. 

Tuberculosis  of  the  Genito-Urinary  Organs,  Male  and  Female.  By  NICH- 
OLAS Senn,  M.  D.,  Ph.  D.,  LL.D.,  Professor  of  the  Practice  of  Surgery  and 
of  Clinical  Surgery,  Rush  Medical  College,  Chicago.  Handsome  octavo 
volume  of  320  pages,  illustrated.     Cloth,  $3.00  net. 

SENN'S  PRACTICAL  SURGERY. 

Practical  Surgery.  By  NICHOLAS  Senn,  M.  D.,  Ph.D.,  LL.D.,  Professor 
of  the  Practice  of  Surgery  and  of  Clinical  Surgery,  Rush  Medical  College, 
Chicago.  Handsome  octavo  volume  of  1200  pages,  profusely  illustrated. 
Cloth,  $6.00  net ;  Sheep  or  Half  Morocco,  $7.00  net.     By  Subscription. 

SENN'S  SYLLABUS  OF  SURGERY. 

A  Syllabus  of  Lectures  on  the  Practice  of  Surgery,  arranged  in  conformity 
with  "  An  American  Text-Book  of  Surgery."  By  NICHOLAS  Senn,  M.  D., 
Ph.D.,  LL.D.,  Professor  of  the  Practice  of  Surgery  and  of  Clinical  Surgery. 
Rush  Medical  College,  Chicago.     Cloth,  $1.50  net. 

SENN'S  TUMORS.    Second  Edition,  Revised. 

Pathology  and  Surgical  Treatment  of  Tumors.  By  NICHOLAS  SENN,  M.  D., 
Ph.D.,  LL.D.,  Professor  of  the  Practice  of  Surgery  and  of  Clinical  Surgery, 
Rush  Medical  College,  Chicago.  Octavo  volume  of  718  pages,  with  478 
illustrations,  includidg  12  full-page  plates  in  colors.  Cloth,  #5.00  net ;  Sheep 
or  Half  Morocco,  $6.00  net. 

STARR'S  DIETS  FOR  INFANTS  AND  CHILDREN. 

Diets  for  Infants  and  Children  in  Health  and  in  Disease.  By  Louis  Starr, 
M.  D.,  Editor  of  "  An  American  Text-Book  of  the  Diseases  of  Children." 
230  blanks  (pocket-book  size),  perforated  and  neatly  bound  in  flexible 
morocco.     $1.25  net. 

STENGEL'S  PATHOLOGY.  Third  Edition,  Thoroughly  Revised. 

A  Text-Book  of  Pathology.  By  Alfred  Stengel.  M.  D.,  Professor  of 
Clinical  Medicine,  University  of  Pennsylvania ;  Visiting  Physician  to  the 
Pennsylvania  Hospital.  Handsome  octavo,  873  pages,  nearly  400  illustra- 
tions, many  of  them  in  colors.  Cloth,  $5.00  net;  Sheep  or  Half  Morocco, 
$6.00  net. 

STENGEL  AND  WHITE  ON  THE  BLOOD. 

The  Blood  in  its  Clinical  and  Pathological  Relations.  By  ALFRED  STEN- 
GEL. M.  D.,  Professor  of  Clinical  Medicine,  University  of  Pennsylvania;  and 
C.  Y.  White,  Jr.,  M.  D.,  Instructor  in  Clinical  Medicine,  University  of 
Pennsylvania.     In  Press. 


OF   IT.    /»'.    SAUNDERS  &   CO.  1 3 

STEVENS'  MATERIA  MEDICA  AND  THERAPEUTICS.    Third 
Edition,  Revised  and  Greatly  Enlarged. 

A  Text-Book  of  Modern  Therapeutics.  By  A.  A.  Stevens,  A.  M.,  M.  I)., 
Lecturer  on  Physical  Diagnosis  in  the  University  of  Pennsylvania. 

STEVENS'  PRACTICE  OF  MEDICINE.     Fifth  Edition,  Revised. 

A  Manual  of  the  Practice  of  Medicine.  By  A.  A.  STEVENS,  A.  ML,  M.  I)., 
Lecturer  on  Physical  Diagnosis  in  the  University  of  Pennsylvania.  Spe- 
cially intended  for  students  preparing  for  graduation  and  hospital  examina- 
tions.    Post-octavo,  519  pages;  illustrated.     Flexible  Leather,  $2.00  net. 

STEWART'S  PHYSIOLOGY.     Fourth  Edition,  Revised. 

A  Manual  of  Physiology,  with  Practical  Exercises.  For  Students  and  Prac- 
titioners. By  G.  N.  Stewart,  M.  A.,  M.  D.,  D.  Sc,  Professor  of  Physiol- 
ogy in  the  Western  Reserve  University,  Cleveland,  Ohio.  Octavo  volume 
of  894  pages  ;  336  illustrations  and  5  colored  plates.     Cloth,  $3.75  net. 

STONEY'S  MATERIA  MEDICA  FOR  NURSES. 

Materia  Medica  for  Nurses.  By  Emily  A.  M.  Stonev,  late  Superintend- 
ent of  the  Training-School  for  Nurses,  Carney  Hospital,  South  Boston, 
Mass.     Handsome  octavo  volume  of  306  pages.     Cloth,  $1.50  net. 

STONEY'S  NURSING.    Second  Edition,  Revised. 

Practical  Points  in  Nuiising.  For  Nurses  in  Private  Practice.  By  Emily 
A.  M.  Stoney,  late  Superintendent  of  the  Training-School  for  Nurses, 
Carney  Hospital,  South  Boston,  Mass.  456  pages,  with  73  engravings  and 
8  colored  and  half-tone  plates.     Cloth,  $1.75  net. 

STONEY'S  SURGICAL  TECHNIC  FOR  NURSES. 

Bacteriology  and  Surgical  Technic  for  Nurses.  By  Emily  A.  M.  STONEY, 
late  Superintendent  of  the  Training-School  for  Nurses,  Carney  Hospital, 
South  Boston,  Mass.     121110  volume,  fully  illustrated.     Cloth,  $1.25  net. 

THOMAS'S  DIET  LISTS.     Second  Edition,  Revised. 

Diet  Lists  and  Sick-Room  Dietary.  By  Jerome  B.  Thomas,  M.D.,  In- 
structor in  Materia  Medica,  Long  Island  Hospital ;  Assistant  Bacteriologist 
to  the  Hoagland  Laboratory.     Cloth,  $1.25  net.     Send  for  sample  sheet. 

THORNTON'S  DOSE=BOOK  AND  PRESCRIPTION=WRITING. 

Second  Edition,  Revised  and  Enlarged. 

Dose-Book  and  Manual  of  Prescript!  in-Writing.  By  E.  Q.  THORNTON, 
M.  D.,  Demonstrator  of  Therapeutics,  Jefferson  Medical  College,  Philadel- 
phia. 

VAN  VALZAH  AND  NISBET'S  DISEASES  OF  THE  STOMACH. 

Diseases  of  the  Stomach.  By  William  W.  Van  Valzah,  M.  D.,  Pro- 
fessor of  General  Medicine  and  Diseases  of  the  Digestive  System  and  the 
Blood,  New  York  Polyclinic;  and  T.  DOUGLAS  NlSBET,  M.  D.,  Adjunct 
Professor  of  General  Medicine  and  Diseases  of  the  Digestive  System  and 
the  Blood,  New  York  Polyclinic.  Octavo  volume  of  674  pages,  illustrated. 
Cloth,  $3. so  net. 


i4  MEDICAL   PUBLICATIONS. 


VECKI'S  SEXUAL  IMPOTENCE,    Second  Edition,  Revised. 

The  Pathology  and  Treatment  of  Sexual  Impotence.  By  VICTOR  G.  VECKI, 
M.  D.  From  the  second  German  edition,  revised  and  enlarged.  Demi- 
octavo,  291  pages.     Cloth,  $2  00  net. 

VIERORDT'S    MEDICAL    DIAGNOSIS.     Fourth    Edition,  Re= 
vised. 

Medical  Diagnosis.  By  Dr.  Oswald  Vierordt,  Professor  of  Medicine, 
University  of  Heidelberg.  Translated,  with  additions,  from  the  fifth  en- 
larged German  edition,  with  the  author's  permission,  by  FRANCIS  H. 
Stuart  A  M.,  M.D.  Handsome  octavo  volume,  603  pages;  194  wood- 
cuts, many  of  them  in  colors.  Cloth,  4.00  net ;  Sheep  or  Half-Morocco, 
$5.00  net. 

WATSON'S  HANDBOOK  FOR  NURSES. 

A  Handbook  for  Nurses.  By  J.  K.  Watson,  M.D.  Edin.  American 
Edition,  under  supervision  of  A.  A.  STEVENS,  A.M.,  M.  D.,  Lecturer  on 
Physical  Diagnosis,  University  of  Pennsylvania.  121110,  413  pages,  73  illus- 
trations.    Cloth,  #1.50  net. 

WARREN'S  SURGICAL  PATHOLOGY.    Second  Edition. 

Surgical  Pathology  and  Therapeutics.  By  John  Collins  Warren,  M.  D., 
LL.D.,  F.  R.  C.  S.  (Hon.),  Professor  of  Surgery,  Harvard  Medical  School. 
Handsome  octavo,  873  pages  ;  136  relief  and  lithographic  illustrations,  33  in 
colors.  With  an  Appendix  on  Scientific  Aids  to  Surgical  Diagnosis,  and  a 
series  of  articles  on  Regional  Bacteriology.  Cloth,  $5.00  net;  Sheep  or 
Half  Morocco,  $6.00  net. 


SAUNDERS* 
QUESTION  =  COMPENDS, 


ARRANGED  IN  QUESTION  AND  ANSWER  FORM. 


The  Most  Complete  and  Best  Illustrated  Series  of  Compends  Ever  Issued. 


NOW  THE  STANDARD  AUTHORITIES  IN  MEDICAL  LITERATURE 

WITH 

Students  and  Practitioners  in  every  City  of  the  United  States  and  Canada. 


Since  the  issue  of  the  first  volume  of  the  Saunders  Question-Compends. 

OVER  200,000  COPIES 

of   these   unrivalled   publications    have   been   sold.      This   enormous   sale   is   indisputable 
evidence  of  the  value  of  these  self-helps  to  students  and  physicians. 

SEE  NEXT  PAGE  FOR  LIST. 


Sau  riders' 

Question  =  Compend    Series 

Price,  Cloth,  $1.00  net  per  copy,  except  when  otherwise  noted. 


"  Where  the  work  of  preparing  students'  manuals  is  to  end  we  cannot  say,  but  the  Saunders 
Series,  in  our  opinion,  bears  off  the  palm  at  present." — New  York  Medical  Record. 


1.  Essentials   Of   Physiology.      By   Sidney   Budgett,   M.  D.    An  entirely   new 

■work. 

2.  Essentials  Of  Surgery.     By  EDWARD  Martin,  M.  D.     Seventh  edition,  revised, 

with  an  Appendix  and  a  chapter  on  Appendicitis. 

3.  Essentials  Of  Anatomy.     By  Charles   B.   Nancrede,   M.  D.     Sixth   edition, 

thoroughly  revised  and  enlarged. 

4.  Essentials  of  Medical  Chemistry,  Organic  and  Inorganic.    By  Lawrence 

Wolff,  M.  D.     Fifth  edition,  revised. 

5.  Essentials  Of  Obstetrics.     By  W.  Easterly  Ashton,  M.  D.     Fourth  edition, 

revised  and  enlarged. 

6.  Essentials  of  Pathology  and  Mortoid  Anatomy.    By  F.  J.  Kalteyer,  M.  D. 

In  preparation. 

1.    Essentials  of  Materia  Medica,  Therapeutics,  and  Prescription-Writing. 

By  Henry  Morris,  M.  D.     Fifth  edition,  revised. 

8,  9.  Essentials  Of  Practice  Of  Medicine.  By  Henry  Morris,  M.  D.  An  Ap- 
pendix on  Urine  Examination.  By  Lawrence  Wolff,  M.  D.  Third  edition, 
enlarged  by  some  300  Essential  Formulae,  selected  from  eminent  authorities,  by 
Wm.  M.  Powell,  M.  D.     (Double  number,  #1.50  net.) 

10.  Essentials   Of    Gynecology.     By   Edwin   B.   Cragin,   M.  D.        Fifth    edition, 

revised. 

11.  Essentials  of  Diseases  of  the  Skin.    By  Henry  w.  Stelwagon,  M.  D. 

Fourth  edition,  revised  and  enlarged. 

12.  Essentials  of  Minor  Surgery,  Bandaging,  and  Venereal  Diseases.    By 

Edward  Martin,  M.  D.     Second  edition,  revised  and  enlarged. 

13.  Essentials  of  Legal  Medicine,  Toxicology,  and  Hygiene.    This  volume  is 

at  present  out  of  print. 

14.  Essentials  of  Diseases  of  the  Eye.    By  Edward  Jackson,  M.  D.    Third 

edition,  revised  and  enlarged. 

15.  Essentials  Of  Diseases  Of  Children.     By  William  M.  Powell,  M.  D.    Third 

16.  Essentials  Of  Examination  Of  Urine.     By  Lawrence  Wolff,  M.  D.     Colored 

"  Vogel  Scale."     (75  cents  net.) 

17.  Essentials  of  Diagnosis.    By  S.  Solis-Cohen,  M.  D.,  and  A.  A.  Eshner,  m.  D. 

Second  edition,  thoroughly  revised. 

18.  Essentials  Of  Practice  Of  Pharmacy.     By  Lucius  E.  Sayre.    Second  edition, 

revised  and  enlarged. 

19.  Essentials  of  Diseases  of  the  Nose  and  Throat.    By  E.  B.  Glbason,  M.  D 

Third  edition,  revised  and  enlarged. 

20.  Essentials  Of  Bacteriology.     By  M.  V.  Ball,  M.  D.     Fourth  edition,  revised. 

21.  Essentials  of  Nervous  Diseases  and  Insanity.    By  John  C.  Shaw,  M.  D. 

Third  edition,  revised. 

22.  Essentials  Of  Medical  PhysiCS.     By  Fred  J.  Brockway,  M.  D.     Second  edi- 

tion, revised. 

23.  Essentials  Of  Medical  Electricity.     By  David  D.  Stewart.  M.  D.,  and  Ed- 

ward S.  Lawrance,  M.  D. 

24.  Essentials  of  Diseases  of  the  Ear.    By  E.  B.  Gleason,  M.  D.    Second  edition, 

revised  and  greatly  enlarged. 

25.  Essentials  Of  Histology.     By  Louis  Leroy,  M.  D.     With  73  original  illustrations. 


Pamphlet  containing  specimen  pages,  etc.,  sent  free  upon  application. 

15 


Saunders'  Medical  Hand = Atlases. 


VOLUMES  NOW  READY. 

ATLAS    AND    EPITOME    OF    INTERNAL    MEDICINE    AND 
CLINICAL   DIAGNOSIS. 

By  Dr.  Chr.  Jakob,  of  Erlangen.  Edited  by  Augustus  A.  Eshner, 
M.  D.,  Professor  of  Clinical  Medicine,  Philadelphia  Polyclinic.  With  179 
colored  figures  on  68  plates,  64  text-illustrations,  259  pages  of  text.  Cloth, 
$3.00  net. 

ATLAS  OF  LEGAL  MEDICINE. 

By  Dr.  E.  R.  von  Hoffman,  of  Vienna.  Edited  by  Frederick  Peter- 
son, M.  D.,  Chief  of  Clinic,  Nervous  Department,  College  of  Physicians  and 
Surgeons,  New  York.  With  120  colored  figures  on  56  plates  and  193  beau- 
tiful half-tone  illustrations.     Cloth,  $3.50  net. 

ATLAS  AND  EPITOME  OF  DISEASES  OF  THE  LARYNX. 

By  Dr.  L.  Grunwald,  of  Munich.  Edited  by  Charles  P.  Grayson, 
M.  D.,  Physician-in-Charge,  Throat  and  Nose  Department,  Hospital  of  the 
University  of  Pennsylvania.  With  107  colored  figures  on  44  plates,  25  text- 
illustrations,  and  103  pages  of  text.     Cloth,  $2.50  net. 

ATLAS  AND  EPITOME  OF  OPERATIVE  SURGERY. 

By  Dr.  O.  Zuckerkandl,  of  Vienna.  Edited  by  J.  Chalmers  DaCosta, 
M.  D.,  Professor  of  Principles  of  Surgery  and  Clinical  Surgery,  Jefferson 
Medical  College,  Philadelphia.  With  24  colored  plates,  214  text-illustra- 
tions, and  395  pages  of  text.     Cloth,  $3.00  net. 

ATLAS  AND  EPITOME  OF  SYPHILIS  AND  THE  VENEREAL 
DISEASES. 

By  Prof.  Dr.  Franz  Mracek,  of  Vienna.  Edited  by  L.  Bolton  Bangs, 
M.  D.,  Professor  of  Genito-Urinary  Surgery,  University  and  Bellevue  Hos- 
pital Medical  College,  New  York.  With  71  colored  plates,  16  illustrations, 
and  122  pages  of  text.     Cloth,  $3.50  net. 

ATLAS  AND  EPITOME  OF  EXTERNAL  DISEASES  OF  THE 
EYE. 

By  Dr.  O.  Haab,  of  Zurich.  Edited  by  G.  E.  DE  Schweinitz,  M.  D., 
Professor  of  Ophthalmology,  Jefferson  Medical  College,  Philadelphia.  With 
76  colored  illustrations  on  40  plates  and  228  pages  of  text.     Cloth,  $3.00  net. 

ATLAS  AND  EPITOME  OF  SKIN  DISEASES. 

By  Prof.  Dr.  Franz  Mracek,  of  Vienna.  Edited  by  Henry  W.  Stel- 
WAGON.  M.D.,  Clinical  Professor  of  Dermatology,  Jefferson  Medical  Col- 
lege, Philadelphia.  With  63  colored  plates,  39  half-tone  illustrations,  and 
200  pages  of  text.     Cloth,  $3.50  net. 

ATLAS  AND   EPITOME  OF  SPECIAL  PATHOLOGICAL  HIS= 
TOLOGY. 

By  Dr.  H.  Durck,  of  Munich.  Edited  by  Ludwig  Hektoen,  M.  D., 
Professor  of  Pathology,  Rush  Medical  College,  Chicago.  In  Two  Parts. 
Part  I.  Ready,  including  Circulatory,  Respiratory,  and  Gastro-intestinal 
Tract,  120  colored  figures  on  62  plates,  158  pages  of  text,  Part  II.  Ready 
Shortly.     Price  of  Part  I.,  $3.00  net. 

16 


Saunders'  Medical  Hand= Atlases. 


VOLUMES  JUST  ISSUED. 
ATLAS  AND  EPITOME   OF   DISEASES  CAUSED   BY   ACCI- 
DENTS. 

By  Dr.  Ed.  GOLEBIEWSKI,  of  Berlin.  Translated  and  edited  with  addi- 
tions by  PEARCE  BAILEY,  M.  D.p  Attending  Physician  to  the  Department 
of  Corrections  and  to  the  Almshouse  and  Incurable  Hospitals,  New  York. 
With  40  colored  plates,  143  text-illustrations,  and  600  pages  of  text.  Cloth, 
54.00  net. 

ATLAS  AND  EPITOME  OF  GYNECOLOGY. 

By  Dk  O.  SHAEFFER,  of  Heidelberg.  From  the  Second  Revised  German 
Edition.  Edited  by  RICHARD  C.  Nurris,  A.  M.,  M.D.,  Gynecologist  to 
the  Methodist  Episcopal  and  the  Philadelphia  Hospitals;  Surgeon-in-Charge 
of  Preston  Retreat,  Philadelphia.  With  90  colored  plates,  65  text-illustra- 
tions,  and  308  pages  of  text.     Cloth,  #3.50  net. 

ATLAS   AND    EPITOME  OF   THE   NERVOUS  SYSTEM  AND 
ITS  DISEASES. 

By  PROFESSOR  Dr.  Chr.  JAKOB,  of  Erlangen.  From  the  Second  Revised 
and  Enlarged  German  Edition.  Edited  by  EDWARD  D.  Fisher,  M.  D., 
Professor  of  Diseases  of  the  Nervous  System,  University  and  Bellevue  Hos- 
pital Medical  College,  New  York.  With  83  plates  and  a  copious  text. 
fe.50  net. 

ATLAS  AND   EPITOME  OF   LABOR    AND  OPERATIVE    OB- 
STETRICS. 

By  DR.  O.  SHAEFFER,  of  Heidelberg.  From  the  Fifth  Revised  and  Enlarged 
German  Edition.  Edited  by  J.  Clifton  Edgar,  M.  D.,  Professor  of  Ob- 
stetrics and  Clinical  Midwifery,  Cornell  University  Medical  School.  With 
126  colored  illustrations.     $2.00  net. 

ATLAS  AND  EPITOME  OF  OBSTETRICAL  DIAGNOSIS  AND 
TREATMENT. 

By  Dr.  O.  SHAEFFER,  of  Heidelberg.  From  the  Second  Revised  and  En- 
larged German  Edition.  Edited  by  J.  CLIFTON  EDGAR,  M.D.,  Professor 
of  Obstetrics  and  Clinical  Midwifery,  Cornell  University  Medical  School. 
72  colored  plates,  numerous  text-illustrations,  and  copious  text.     $3-°°  net. 

ATLAS  AND  EPITOME  OF  OPHTHALMOSCOPY  AND  OPH- 
THALMOSCOPIC DIAGNOSIS. 

By  Dr.  O.  Haab,  of  Zurich.  From  the  Third  Revised  and  Enlarged  Ger- 
man Edition.  Edited  by  G.  E.  DE  Schweinitz,  M.D.,  Professor  of  Oph- 
thalmology, Jefferson  Medical  College,  Philadelphia.  With  152  colored 
figures  and  82  pages  of  text.     Cloth,  $3.00  net. 

ATLAS  AND  EPITOME  OF   BACTERIOLOGY. 

Including  a  Hand-Book  of  Special  Bacteriologie  Diagnosis.  By  Prof.  Dr. 
K.  B.  Lehmann  and  Dr.  R.  O.  Neumann,  of  Wurzburg.  From  tin-  Second 
Revised  German  Edition.  Edited  by  GEORGE  H.  Weaver,  M.  D.,  Assistant 
Professor  of  Pathology  and  Bacteriology,  Rush  Medical  College,  Chicago. 
Two  volumes,  with  over  600  colored  lithographic  figures,  numerous  text- 
illustrations,  and  500  pages  of  text. 


ADDITIONAL  VOLUMES  IN  PREPARATION. 

17 


Nothnagel's  Encyclopedia 

OF 

PRACTICAL    MEDICINE. 

Edited  by  ALFRED  STENGEL,  M.D., 

Professor  of  Clinical  Medicine  in  the  University  of  Pennsylvania;  Visiting 
Physician  to  the  Pennsylvania  Hospital. 

IT  is  universally  acknowledged  that  the  Germans  lead  the  world  in  Internal  Medicine  ; 
and  of  all  the  German  works  on  this  subject.  Nothnagel's  "  Special  Pathology  and 
Therapeutics "  is  conceded  by  scholars  to  be  without  question  the  best  System  of 
Medicine  in  existence.  So  necessary  is  this  book  in  the  study  of  Internal  Medicine 
that  it  comes  largely  to  this  country  in  the  original  German.  In  view  of  these  facts, 
Messrs.  W.  B.  Saunders  &  Company  have  arranged  with  the  publishers  to  issue  at  once 
an  authorized  edition  of  this  great  encyclopedia  of  medicine  in  English. 

For  the  present  a  set  of  some  ten  or  twelve  volumes,  representing  the  most  practical 
part  of  this  encyclopedia,  and  selected  with  especial  thought  of  the  needs  of  the  practical 
physician,  will  be  published.  These  volumes  will  contain  the  real  essence  of  the  entire 
work,  and  the  purchaser  will  therefore  obtain  at  less  than  half  the  cost  the  cream  of  the  origi- 
nal.    Later  the  special  and  more  strictly  scientific  volumes  will  be  offered  from  time  to  time. 

The  work  will  be  translated  by  men  possessing  thorough  knowledge  of  both  English  and 
German,  and  each  volume  will  be  edited  by  a  prominent  specialist  on  the  subject  to 
which  it  is  devoted.  It  will  thus  be  brought  thoroughly  up  to  date,  and  the  American  edition 
will  be  more  than  a  mere  translation  of  the  German;  for,  in  addition  to  the  matter  contained 
in  the  original,  it  will  represent  the  very  latest  views  of  the  leading  American  special- 
ists in  the  various  departments  of  Internal  Medicine.  The  whole  System  will  be  under  the 
editorial  supervision  of  Dr.  Alfred  Stengel,  who  will  select  the  subjects  for  the  American 
edition,  and  will  choose  the  editors  of  the  different  volumes. 

Unlike  most  encyclopedias,  the  publication  of  this  work  will  not  be  extended  over  a 
number  of  years,  but  five  or  six  volumes  will  be  issued  during  the  coming  year,  and  the 
remainder  of  the  series  at  the  same  rate.  Moreover,  each  volume  will  be  revised  to  the 
date  of  its  publication  by  the  American  editor.  This  will  obviate  the  objection  that  has 
heretofore  existed  to  systems  published  in  a  number  of  volumes,  since  the  subscriber  will 
receive  the  completed  work  while  the  earlier  volumes  are  still  fresh. 

The  usual  method  of  publishers,  when  issuing  a  work  of  this  kind,  has  been  to  compel 
physicians  to  take  the  entire  System.  This  seems  to  us  in  many  cases  to  be  undesirable. 
Therefore,  in  purchasing  this  encyclopedia,  physicians  will  be  given  the  opportunity  of 
subscribing  for  the  entire  System  at  one  time ;  but  any  single  volume  or  any  number  of 
volumes  may  be  obtained  by  those  who  do  not  desire  the  complete  series.  This  latter 
method,  while  not  so  profitable  to  the  publisher,  offers  to  the  purchaser  many  advan- 
tages which  will  be  appreciated  by  those  who  do  not  care  to  subscribe  for  the  entire  work 
at  one  time. 

This  American  edition  of  Nothnagel's  Encyclopedia  will,  without  question,  form  the 
greatest  System  of  Medicine  ever  produced,  and  the  publishers,  fee}  confident  that  i{ 
will  meet  with  general  favor  in  the  medical  profession. 

l8 


NOTHNAGEL'S  ENCYCLOPEDIA 

VOLUMES  JUST  ISSUED  AND  IN  PRESS 


VOLUME  I 

Editor,  William  Osier,  M.  D., 

F.  R.  C.P. 


Profei 


of  Medicine  in  Johns  Hopkins 
University 


CONTENTS 
Typhoid  Fever.    By  J'k.  H.  Curschmann, 
of  Leipsic,     Typhus  Fever.    By  Dr.   H. 
Curschmann,  of  Leipsic. 

Handsome  octavo  volume  of  about  600  pages. 
Just  Issued 


VOLUME  II 

Editor,  Sir  J.  W.  Moore,  B.  A.,  M.  D., 

F.R.C.P.L,  of  Dublin 

Professor  of  Practice  of  Medicine,  Royal 
College  of  Surgeons  in  Ireland 

CONTENTS 

Erysipelas  and  Erysipeloid.  By  Dr.  H. 
Lenhaktz,  of  Hamburg.  Cholera  Asi- 
atica  and  Cholera  Nostras  By  Dr. 
K.  von  Lieuermeister,  of  Tubingen, 
Whooping  Cough  and  Hay  Fever.  By 
Dr.  G.  Sticker,  of  Giessen.  Varicella. 
By  Dr.  Th.  von  Jurgensen,  of  Tubingen. 
Variola  (including  Vaccination).  By 
Dr.  H.  Immermann,  of  Basle. 

Handsome  octavo  volume  of  over  700  pages. 
Just  Issued 


VOLUME  VII 
Editor,  John  H.  Musser,  M.  D. 
Professor  oj  Clinical  Medicine,  Univet 
0/  Pennsylvania 

CONTENTS 

Diseases  of  the  Bronchi.  By  Dr.  I.  A 
Hoffmann,  of  Leipsic.  Diseases  of  the 
Heura.  By  Du.  RoSENBACH,  ■>!  Berlin. 
Pneumonia.      By   Du.   E.  AuFKBCHT,  oi 

Magdeburg. 


VOLUME  VIII 
Editor,  Charles  G.  Stockton,  M.  D. 

Professor  of  Medicine,  University  of  Buffalo 

CONTENTS 
Diseases    of  the    Stomach.      By   Du.    F. 
RlEGEL,  of  Giessen. 


VOLUME  IX 
Editor,  Frederick  A.  Packard,  M.  D. 

Physician  to  the  Pennsylvania  Hospital  and 
to  the  Children's  Hospital,  Philadelphia 

CONTENTS 

Diseases    of   the     Liver.       By    Drs.    H. 
Quincke  and  G.  Hoppe-Seyler,  of  Kiel. 


volume  in 

Editor,  William  P.  Northrop,  M.  D. 

Professor  of  Pediatrics,  University  and 
Bellevue  Medical  College 

CONTENTS 

Measles.  By  Dr.  Th.  von  Jurgensen,  of 
Tubingen.  Scarlet  Fever.  By  the  same 
author.      Rotheln.    By  the  same  author. 


VOLUME  X 
Editor,  Reginald  H.  Fitz,  A.  M.,  M.D. 

Hersey  Professor  of  the  Theory  and  Prac- 
tice of  Physic,  Harvard  University 

CONTENTS 

Diseases  of  the  Pancreas.  By  Dr.  L. 
Oser,  of  Vienna.  Diseases  of  the  Supra- 
renals.     By  Dr.  L.  Neusser,  of  \  ienna. 


VOLUME  VI 
Editor,  Alfred  Stengel,  M,  D. 

Professor  of  Clinical  Medicine,  University 
of  Pennsylvania 

CONTENTS 

Anemia.  By  Dr.  P.  Ehrlich,  of  Frank- 
fort-on-the-Main,  and  Dr.  A.  Lazarus,  of 
Charlottenbuig.  Chlorosis.  By  Dr.  K. 
von  Noorden,  of  Frankfort-on-the-Main. 
Diseases  of  the  Spleen  a"nd  Hemor- 
rhagic Diathesis.  By  Dr.  M.  Litten, 
of  Berlin. 


VOLUMES  IV,  V,  and  XI 
Editors  announced  later 

Vol.  IV. — Influenza  and  Dengue.  By  Dr. 
O.  Leichtenstein,  of  Cologne.  Malarial 
Diseases.     By    Dr.   J.   Mannaberg,   of 

Vienna. 

Vol.V. — Tuberculosis  and  Acute  General 
Miliary  Tuberculosis.  By  Dr.  G.  Cor- 
net, of  Berlin. 

Vol.  XI.  —  Diseases  of  th?  Intestines  and 
Peritoneum.  By  I>r.  H.  Nothnagel, 
of  Vienna. 


19 


CLASSIFIED  LIST 

OF  THE 

MEDICAL    PUBLICATIONS 

OF 

W.  B.  SAUNDERS  &  COMPANY 


ANATOMY,  EMBRYOLOGY,  HIS- 
TOLOGY. 

Bohm,  Davidoff,  and  Huber— A  Text- 
Book  of  Histology, 4 

Clarkson— A  Text-Book  of  Histology,   .  5 

Haynes— A  Manual  of  Anatomy,   ...  7 

Heisler— A  Text-Book  of  Embryology,  .  7 

Leroy — Essentials  of  Histology,    ....  15 

Nancrede — Essentials  of  Anatomy,  .    .    .  15 
Nancrede — Essentials  of  Anatomy  and 

Manual  of  Practical  Dissection,  ....  10 

BACTERIOLOGY. 

Ball— Essentials  of  Bacteriology,  ....    15 
Frothingham— Laboratory  Guide,  .    .    .     6 
Gorham — Laboratory    Course  in  Bacte- 
riology,     22 

Lehmann    and     Neumann— Atlas     of 

Bacteriology, *7 

Levy  and  Klemperer's  Clinical  Bacte- 
riology,     9 

Mallory    and     Wright— Pathological 

Technique, 9 

McFarland— Pathogenic  Bacteria,  ...     9 

CHARTS,  DIET-LISTS,  ETC. 

Griffith— Infant's  Weight  Chart,  ....  7 

Hart — Diet  in  Sickness  and  in  Health,    .  7 

Keen — Operation  Blank, 8 

Laine — Temperature  Chart, 9 

Meigs — Feeding  in  Early  Infancy,    ...  10 

Starr — Diets  for  Infants  and  Children,  .  12 

Thomas— Diet-Lists, 13 

CHEMISTRY  AND  PHYSICS. 
Brockway  —  Essentials    of   Medical 
Physics, J5 

Wolff— Essentials  of  Medical  Chemistry,    15 

CHILDREN. 

An  American  Text-Book  of  Diseases 

of  Children 1 

Griffith— Care  of  the  Baby 7 

Griffith— Infant's  Weight  Chart,  ....  7 
Meigs — Feeding  in  Early  Infancy,   .    .    .  10 
Powell — Essentials  of  Diseases  of  Chil- 
dren,       J5 

Starr— Diets  for  Infants  and  Children,    .  12 

DIAGNOSIS. 

Cohen  and  Eshner— Essentials  of  Diag- 
nosis,     15 

Corwin — Physical  Diagnosis, 5 

Vierordt— Medical  Diagnosis, 14 

DICTIONARIES. 

The  American  Illustrated  Medical 
Dictionary, 3 

The  American  Pocket  Medical  Dic- 
tionary, 


EYE,  EAR,  NOSE,  AND  THROAT. 
An  American  Text-Book  of  Diseases 

of  the  Eye,  Ear,  Nose,  and  Throat,  .    .      1 
De  Schweinitz — Diseases  of  the  Eye,    .     6 
Friedrich  and  Curtis— Rhinology,  Lar- 
yngology, and  Otology, 6 

Gleason — Essentials  of  the  Ear,    ....    15 
Gleason — Essentials  of  Nose  and  Throat,  15 
Gradle — Ear,  Nose,  and  Throat,  ....   22 
Grunwald  and  Grayson — Atlas  of  Dis- 
eases of  the  Larynx, 16 

Haab  and  de  Schweinitz— Atlas  of  Ex- 
ternal Diseases  of  the  Eye, 16 

Jackson — Manual  of  Diseases  of  the  Eye,  8 
Jackson — Essentials  Diseases  of  Eye,  .  15 
Kyle — Diseases  of  the  Nose  and  Throat,     9 

GENITO-URINARY. 

An  American  Text-Book  of  Genito- 
urinary and  Skin  Diseases, 2 

Hyde  and  Montgomery— Syphilis  and 
the  Venereal  Diseases, 8 

Martin — Essentials  of  Minor  Surgery, 
Bandaging,  and  Venereal  Diseases,  .    .    15 

Mracek  and  Bangs — Atlas  of  Syphilis 
and  the  Venereal  Diseases, 16 

Saundby — Renal  and  Urinary  Diseases,   11 

Senn — Genito-Urinary  Tuberculosis,   .   .   12 

Vecki — Sexual  Impotence, 14 


GYNECOLOGY. 
American  Text-Book  of  Gynecology,   . 
Cragin — Essentials  of  Gynecology,  .    .   . 
Garrigues — Diseases  of  Women,  .    .    .   . 
Long — Syllabus  of  Gynecology,   .    .    .   . 

Penrose — Diseases  of  Women, 

Pryor— Pelvic  Inflammations, 

Schaeffer  and  Norris— Atlas  of  Gyne- 
cology,      


17 


Morton— Nurses'  Dictionary, 10 


HYGIENE. 

Abbott — Hygiene  of  Transmissible  Dis- 
eases,          3 

Bergey — Principles  of  Hygiene,  ....   22 
Pyle — Personal  Hygiene, n 

MATERIA      MEDICA,      PHARMA- 
COLOGY, and  THERAPEUTICS. 
An  American   Text-Book  of  Applied 

Therapeutics 1 

Butler — Text-Book   of  Materia  Medica, 

Therapeutics,  and  Pharmacology,  .  .  4 
Morris — Ess. of  M.  M.  and  Therapeutics,  15 
Saunders'  Pocket  Medical  Formulary,  .  11 
Sayre — Essentials  of  Pharmacy,  ....  15 
Sollmann — Text-Book  of  Pharmacology,  22 
Stevens — Modern  Therapeutics,  ....  13 
Stoney— Materia  Medica  for  Nurses,  .  .  13 
Thornton — Prescription-Writing,     ...   13 


MEDIC  A  L   P  U/i  /.  ICA  TIONS 


MEDICAL  JURISPRUDENCE  AND 
TOXICOLOGY. 

Chapman — Medical    Jurisprudence    and 
Toxicology 5 

Golebiewski  and  Bailey— Atlas  of  Dis- 
eases Caused  by  Accidents 17 

Hofmann  and  Peterson— Atlas  of  Legal 
Medicine,        16 

NERVOUS  AND  MENTAL  DIS- 
EASES, ETC. 

Brower — Manual  of  Insanity 22 

Chapin — Compendium  of  Insanity,  .    .    .      5 
Church    and    Peterson — Nervous  and     5 

Mental  Diseases, 5 

Jakob  and    Fisher — Atlas   of    Nervous 

System, 17 

Shaw — Essentials  of  Nervous   Diseases 

and  Insanity, 15 


NURSING. 
Davis — Obstetric  and  Gynecologic  Nurs- 
ing,    

Griffith— The  Care  of  the  Baby,  .  . 
Hart — Diet  in  Sickness  and  in  Health, 
Meigs — Feeding  in  Early  Infancy,  . 
Morten — Nurses'  Dictionary,  .  .  . 
Stoney — Materia  Medica  for  Nurses, 
Stoney — Practical  Points  in  Nursing, 
Stoney — Surgical  Technic  for  Nurses, 
Watson — Handbook  for  Nurses,  .    .    . 


J7 


OBSTETRICS. 

An  American  Text-Book  of  Obstetrics, 
Ashton — Essentials  of  Obstetrics,  . 
Boisliniere— Obstetric  Accidents, 
Dorland — Modern  Obstetrics,  ,  . 
Hirst — Text-Book  of  Obstetrics,  . 
Norris — Syllabus  of  Obstetrics,  .  . 
Schaeffer  and  Edgar — Atlas  of  Obstet 
rical  Diagnosis  and  Treatment,  .    .    . 


PATHOLOGY. 

An  American  Text-Book  of  Pathology.  2 
Durck  and  Hektoen— Atlas  of  Patho- 
logic Histology 16 

Kalteyer — Essentials  of  Pathology,    .    .  15 
Mallory    and    Wright— Pathological 

Technique, 9 

Senn — Pathology,  and    Surgical    Treat- 
ment of  Tumors, 12 

Stengel — Text-Book  of  Pathology,  ...  12 

Warren— Surgical  Pathology, 14 

PHYSIOLOGY. 

American  Text-Book  of  Physiology,  .  2 

Budgett — Essentials  of  Physiology,   .    .  15 

Raymond — Text-Book  of  Physiology,  .  11 

Stewart — Manual  of  Physiology,    .   .  13 

PRACTICE  OF  MEDICINE. 

An  American  Year-Book  of  Medicine 

and  Surgery 3 

Anders  —  Practice  of  Medicine, 4 

Eichhorst — Practice  of  Medicine,  ...  6 

Lockwood — Practice  of  Medicine,  .    .    .  9 

Morris — Ess.  of  Practice  of  Medicine,  .  15 

Salinger  &  Kalteyer — Mod.  Medicine,  ti 

Stevens — Practice  of  Medicine 13 


SKIN  AND  VENEREAL. 

An  American  Text-Book  of  Genito- 
urinary and  Skin  Diseases 2 

Hyde  and  Montgomery  —Syphilis  and 
the  Venereal  I  liseases, 8 

Martin— Essentials  ol  Minor  Surgery, 
Bandaging,  and  Venereal   Diseases, .    .   15 

Mracek  and  Stelwagon— Atlas  of  Dis- 
eases of  the  Skin, i>, 

Stelwagon— Essentials  of  Diseases  of 
the  Skin, 15 

SURGERY. 

An  American  Text-Book  of  Surgery,  2 
An  American  Year-Book  of  Medicine 

and  Surgery, 3 

Beck — Fractures, 4 

Beck — Manual  of  Surgical  Asepsis,  ...  4 

Da  Costa — Manual  of  Surgery, 5 

International  Text-Book  of  Surgery,  .  8 

Keen— Operation  Blank, 8 

Keen — The  Surgical  Complications  and 

Sequels  of  Typhoid  Fever 8 

Macdonald — Surgical     Diagnosis    and 

Treatment, 9 

Martin — Essentials  of    Minor    Surgery, 

Bandaging,  and  Venereal  Diseases,  .    .  15 

Martin — Essentials  of  Surgery, 15 

Moore — Orthopedic  Surgery, 10 

Nancrede — Principles  of  Surgery,  .    .    .  10 

Pye — Bandaging  and  Surgical   Dressing,  n 

Scudder — Treatment  of  Fractures,   ...  12 

Senn — Genito-Urinary  Tuberculosis,   .    .  12 

Senn — Practical  Surgery, 12 

Senn — Syllabus  of  Surgery, 12 

Senn — Pathology  and  Surgical  Treat- 
ment of  Tumors ...  12 

Warren — Surgical  Pathology  and  Ther- 
apeutics,    14 

Zuckerkandl  and  Da  Costa — Atlas  of 

Operative  Surgery, 16 

URINE  AND  URINARY  DISEASES. 
Ogden — Clinical      Examination     of    the 

Urine, 10 

Saundby — Renal  and  Urinary  Diseases,  n 
Wolf — Handbook  of  Urine  Examination,  22 
Wolff — Examination  of  Urine, 15 

MISCELLANEOUS. 
Abbott — Hygiene  of  Transmissible  Dis- 
eases,         3 

Bastin — Laboratory  Exercises  in  Bot- 
any      4 

Golebiewski  and  Bailey— Atlas  of  Dis- 
eases Caused  by  Accidents,  .       .        .    .    17 
Gould  and    Pyle — Anomalies  and  Curi- 
osities of  Medicine 7 

Grafstrom — Massage, 7 

Keating — Examination  for  Life  Insur- 
ance,      S 

Pyle— A  Manual  of  Personal  Hygiene,  .  11 
Saunders'  Medical  Hand-Atlases,  .  16,  17 
Saunders'  Pocket  Medical  Formulary,  .  n 
Saunders'  Question-Compends,  .  .  14.  15 
Stewart  and  Lawrence — Essentials  of 

Medical  Electricity, 15 

Thornton — Dose-Book  and   Manual   of 

Prescription-Writing 13 

Van  Valzah  and  Nisbet — Diseases  of 
the  Stomach, 13 


THE  LATEST  BOOKS. 


Bergey's  Principles  of  Hygiene. 


The  Principles  of  Hygiene :  A  Practical  Manual  for  Students, 
Physicians,  and  Health  Officers.  By  D.  H.  Bergey,  A.M.,  M.  D., 
First  Assistant,  Laboratory  of  Hygiene,  University  of  Pennsyl- 
vania. Handsome  octavo  volume  of  about  500  pages,  illus- 
trated. 


Brower's  Manual  of  Insanity. 


A  Practical  Manual  of  Insanity.  By  Daniel  R.  Brower,  M.D., 
Professor  of  Nervous  and  Mental  Diseases,  Rush  Medical  Col- 
lege, Chicago.      i2mo  volume  of  425  pages,  illustrated. 

Gorham's  Bacteriology. 

A  Laboratory  Course  in  Bacteriology.  By  F.  P.  Gorham, 
M.  A.,  Assistant  Professor  in  Biology,  Brown  University.  i2mo 
volume  of  about  160  pages,  fully  illustrated. 

Gradle  on  the  Nose,  Throat,  and  Ear. 

Diseases  of  the  Nose,  Throat,  and  Ear.  By  Henry  Gradle, 
M.  D.,  Professor  of  Ophthalmology  and  Otology,  Northwestern 
University  Medical  School,  Chicago.  Handsome  octavo  volume 
of  800  pages,  profusely  illustrated. 

Sollmann's  Pharmacology. 

A  Text-Book  of  Pharmacology.  By  Torald  Sollmann,  M.  D., 
Lecturer  on  Pharmacology,  Western  Reserve  University,  Cleve- 
land, Ohio.     Royal  octavo  volume  of  about  700  pages. 

Wolf's  Examination  of  Urine. 

A  Handbook  of  Physiologic  Chemistry  and  Urine  Examination. 
By  Charles  G.  L.  Wolf,  M.  D.,  Instructor  in  Physiologic  Chem- 
istry, Cornell  University  Medical  College,  nmo  volume  of  about 
160  pages. 

22 


DATE  DUE 

•    •**•••                                   tot.. 

RIES 

"  at  the 
rowing, 

MAR 

2  0  1997 

APR  1  0  i 

997 

fe»A*«>^  p 

i^7    I    /^> 

cial  ar- 

At(^#<~«J     t^C 

*,  Tt    \11^ 

rE  DUE 

- 

j 

1 

Printed 
in  USA 

C|»liffilftlHffiRS,TY  L|BRARIES 


0043058051 


RA1051 
Chapman 


C36 
1896 


m 


m 


mm 

SSntM 

KeSHS 
iUnSHraMM 


m 


ms 


wm 


m 


a 


vmm 


